Outcome of Pregnancy Oral Glucose Tolerance Test and Preterm Birth.

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2024-09-01 Epub Date: 2024-05-21 DOI:10.1097/EDE.0000000000001752
Richard Liang, Danielle M Panelli, David K Stevenson, David H Rehkopf, Gary M Shaw, Henrik Toft Sørensen, Lars Pedersen
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Abstract

Background: Gestational diabetes is associated with adverse outcomes such as preterm birth (<37 weeks). However, there is no international consensus on screening criteria or diagnostic levels for gestational diabetes, and it is unknown whether body mass index (BMI) or obesity modifies the relation between glucose level and preterm birth.

Methods: We studied a pregnancy cohort restricted to two Danish regions from the linked Danish Medical Birth Register to study associations between glucose measurements from the 2-hour postload 75-g oral glucose tolerance test (one-step approach) and preterm birth from 2004 to 2018. In Denmark, gestational diabetes screening is a targeted strategy for mothers with identified risk factors. We used Poisson regression to estimate rate ratios (RR) of preterm birth with z-standardized glucose measurements. We assessed effect measure modification by stratifying analyses and testing for heterogeneity.

Results: Among 11,337 pregnancies (6.2% delivered preterm), we observed an adjusted preterm birth RR of 1.2 (95% confidence interval [CI] = 1.1, 1.3) for a one-standard deviation glucose increase of 1.4 mmol/l from the mean of 6.7 mmol/l. There was evidence for effect measure modification by obesity, for example, adjusted RR for nonobese (BMI, <30): 1.2 (95% CI = 1.1, 1.3) versus obese (BMI, ≥30): 1.3 (95% CI = 1.2-1.5), P = 0.05 for heterogeneity.

Conclusion: Among mothers screened for gestational diabetes, increased glucose levels, even those below the diagnostic level for gestational diabetes in Denmark, were associated with increased preterm birth risk. Obesity (BMI, ≥30) may be an effect measure modifier, not just a confounder, of the relation between blood glucose and preterm birth risk.

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孕期口服葡萄糖耐量试验的结果与早产。
背景:妊娠期糖尿病与早产等不良后果有关(方法:我们对丹麦医学出生登记册中两个地区的妊娠队列进行了研究:我们从关联的丹麦出生医学登记册(Danish Medical Birth Register)中选取了一个仅限于丹麦两个地区的妊娠队列,研究2004-2018年期间负荷后2小时75克口服葡萄糖耐量试验(一步法)的葡萄糖测量值与早产之间的关联。在丹麦,妊娠糖尿病筛查是一项针对具有已识别风险因素的母亲的目标策略。我们使用泊松回归法估算了z标准化血糖测量值的早产率比(RR)。我们通过分层分析和异质性检验评估了效应测量修正:在 11,337 名孕妇(6.2% 早产)中,我们观察到,与平均值 6.7 mmol/L 相比,血糖每增加 1.4 mmol/L 为 1 个标准差,调整后的早产 RR 为 1.2(95% CI:1.1-1.3)。有证据表明,肥胖会影响测量结果,例如,非肥胖(体重指数结论)的调整RR:在接受妊娠糖尿病筛查的母亲中,即使血糖水平低于丹麦的妊娠糖尿病诊断水平,血糖水平升高也与早产风险增加有关。肥胖(体重指数≥30)可能是血糖与早产风险之间关系的效应测量调节因子,而不仅仅是混杂因素。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
期刊最新文献
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