背景:轻度高血糖与出生体重增加有关,但与其他新生儿结局的关系存在争议。我们旨在使用不同的口服葡萄糖耐量试验(OGTT)阈值研究未经治疗的轻度高血糖的新生儿结局。
方法:这项基于注册的研究包括2009年在芬兰六家分娩医院参加75g2小时OGTT的所有(n=4,939)单胎孕妇。芬兰GDM的诊断截止日期为空腹≥5.3,1h≥10.0或2h葡萄糖≥8.6mmol/L。不符合这些标准但符合国际糖尿病和妊娠研究组协会(IADPSG)标准(空腹5.1-5.2mmol/L和/或2小时血糖8.5mmol/L,n=509)或美国国立卫生与临床卓越研究所(NICE)标准(2小时葡萄糖7.8-8.5mmol/L,n=166)被认为是轻度未经治疗的高血糖症。符合芬兰标准和IADPSG或NICE标准的女性被视为GDM治疗组(分别为n=1292和n=612)。根据所有标准(空腹血糖<5.1mmol/L,1小时葡萄糖<10.0mmol/L,2小时葡萄糖<8.5mmol/L,n=3031)。将未治疗的轻度高血糖组与对照组和治疗的GDM组进行比较。主要结局-新生儿不良结局的复合,包括新生儿低血糖,高胆红素血症,出生创伤或围产期死亡率-使用多变量逻辑回归分析。
结果:与对照组相比,未经治疗的轻度高血糖的新生儿不良结局的风险没有增加(使用IADPSG标准的调整比值比[aOR]:1.01,95%置信区间[CI]:0.71-1.44;使用NICE标准的aOR:1.05,95%CI:0.60-1.85)。与治疗的IADPSG(aOR0.38,95%CI0.27-0.53)或治疗的NICE组(aOR0.32,95%CI0.18-0.57)相比,风险较低。
结论:与正常血糖对照组相比,轻度未经治疗的高血糖组新生儿不良结局的风险没有增加,并且低于接受治疗的GDM组。空腹时5.3mmol/L和2h时8.6mmol/L的OGTT截止值似乎足以识别临床相关的GDM。不排除有不良后果风险的新生儿。
BACKGROUND: Mild hyperglycaemia is associated with increased birth weight but association with other neonatal outcomes is controversial. We aimed to
study neonatal outcomes in untreated mild hyperglycaemia using different oral glucose tolerance test (OGTT) thresholds.
METHODS: This register-based
study included all (n = 4,939) singleton pregnant women participating a 75 g 2-h OGTT in six delivery hospitals in Finland in 2009. Finnish diagnostic cut-offs for GDM were fasting ≥ 5.3, 1 h ≥ 10.0 or 2-h glucose ≥ 8.6 mmol/L. Women who did not meet these criteria but met the International Association of the Diabetes and Pregnancy
Study Groups (IADPSG) criteria (fasting 5.1-5.2 mmol/L and/or 2-h glucose 8.5 mmol/L, n = 509) or the National Institute for Health and Clinical Excellence (NICE) criteria (2-h glucose 7.8-8.5 mmol/L, n = 166) were considered as mild untreated hyperglycaemia. Women who met both the Finnish criteria and the IADPSG or the NICE criteria were considered as treated GDM groups (n = 1292 and n = 612, respectively). Controls were normoglycaemic according to all criteria (fasting glucose < 5.1 mmol/L, 1-h glucose < 10.0 mmol/L and 2-h glucose < 8.5 mmol/L, n = 3031). Untreated mild hyperglycemia groups were compared to controls and treated GDM groups. The primary outcome - a composite of adverse neonatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, birth trauma or perinatal mortality - was analysed using multivariate logistic regression.
RESULTS: The risk for the adverse neonatal outcome in untreated mild hyperglycemia was not increased compared to controls (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 0.71-1.44, using the IADPSG criteria; aOR: 1.05, 95% CI: 0.60-1.85, using the NICE criteria). The risk was lower compared to the treated IADPSG (aOR 0.38, 95% CI 0.27-0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18-0.57).
CONCLUSIONS: The risk of adverse neonatal outcomes was not increased in mild untreated hyperglycaemia compared to normoglycaemic controls and was lower than in the treated GDM groups. The OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 h seem to sufficiently identify clinically relevant GDM, without excluding neonates with a risk of adverse outcomes.