背景:目前尚不清楚妊娠期糖代谢状况如何影响胎儿结局。本研究旨在探讨妊娠糖尿病(GDM)和口服葡萄糖耐量试验(OGTT)期间每个时间点血糖水平升高与后代先天性心脏病(CHD)风险的关系。
方法:我们对福建省妇幼保健院登记的单胎妊娠20周以上的母亲进行了回顾性队列研究,中国。收集OGTT结果和后代CHD发生情况。我们使用逻辑回归分析OGTT期间每个时间点的血糖升高与CHD之间的关联。
结果:共纳入71,703例正常胎儿和533例冠心病胎儿。与相应的正常组相比,患有GDM的女性,OGTT在不同时间点的血糖升高(0h≥5.1mmol/L,1h≥10mmol/L,和2h≥8.5mmol/L)显示后代冠心病的风险增加(校正OR分别为1.41、1.36、1.37和1.41,所有P<0.05)。与第1组(正常OGTT0h,1h和2h),第3组(OGTT正常0h和OGTT异常1h或2h)和第4组(OGTT异常0h,1h和2h),OR值分别为1.53和2.21,P均<0.05。此外,我们将参与者按高龄划分,multipara,辅助生殖,胎儿性别,和其他人,在亚组分析中观察到相似的关联.
结论:OGTT期间不同时间点的血糖升高与后代的冠心病相关。应筛查GDM孕妇的胎儿是否有冠心病的高风险。
BACKGROUND: It remains unclear how the condition of glucose metabolism during pregnancy affects fetal outcomes. This
study aimed to investigate the associations of gestational diabetes mellitus (GDM) and elevated glucose levels at each time point during oral glucose tolerance test (OGTT) with congenital heart disease (CHD) risk in offspring.
METHODS: We conducted a retrospective cohort
study of mothers with singleton pregnancies of 20 weeks or more registered at Maternal and Child Health Centers in Fujian Province, China. The OGTT results and offspring CHD occurrence were collected. We used logistic regression to analyse the association between elevated blood glucose at each time point during OGTT and CHD.
RESULTS: A total of 71,703 normal and 533 CHD fetuses were included. Compared to the corresponding normal group, women with GDM, elevated blood glucose at different time points in OGTT (0 h ≥ 5.1 mmol/L, 1 h ≥ 10 mmol/L, and 2 h ≥ 8.5 mmol/L) showed an increased risk of CHD in offspring (adjusted OR = 1.41, 1.36, 1.37, and 1.41, all P < 0.05, respectively). Compared to group 1 (normal OGTT 0 h, 1 h and 2 h), the risk of CHD was higher in group 3 (normal OGTT 0 h and abnormal OGTT 1 h or 2 h) and group 4 (abnormal OGTT 0 h, 1 h and 2 h), OR = 1.53 and 2.21, all P < 0.05, respectively. Moreover, we divided participants by advanced maternal age, multipara, assisted reproduction, fetal sex, and others, similar associations were observed in the subgroup analyses.
CONCLUSIONS: Elevated blood glucose at different time points during OGTT was associated with CHD in offspring. Fetuses of pregnant women with GDM should be screened for a high risk of CHD.