Perinatal and neonatal outcomes in gestational diabetes: The importance of the number of abnormal values in an oral glucose tolerance test.

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-10-30 DOI:10.1111/aogs.14999
Sanna Eteläinen, Elina Keikkala, Shilpa Lingaiah, Matti Viljakainen, Tuija Männistö, Anneli Pouta, Risto Kaaja, Johan G Eriksson, Hannele Laivuori, Mika Gissler, Eero Kajantie, Marja Vääräsmäki
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Abstract

Introduction: Gestational diabetes mellitus (GDM) is defined by one or more abnormal values in an oral glucose tolerance test (OGTT). The significance/importance of the number of abnormal values in relation to adverse perinatal and neonatal outcomes is unclear. We assessed the association of these outcomes with the number of abnormal glucose values in a 2-h 75 g OGTT in a large register-based cohort.

Material and methods: This sub-study of the Finnish Gestational Diabetes Study was based on the Finnish Medical Birth Register 2009 supplemented with OGTT laboratory data of 4869 pregnant women from six Finnish hospitals. The diagnostic cut-offs in OGTT according to the Finnish guidelines for plasma samples were ≥5.3 mmol/L (fasting), ≥10.0 mmol/L 1 h or ≥8.6 mmol/L 2 h after the glucose load. As per the guidelines, women with one or several abnormal OGTT values received diet and lifestyle counseling in the primary care, self-monitored their glucose values and received pharmacological therapy as needed. Women with GDM were categorized according to the number of abnormal glucose values. The primary outcomes, composites of adverse perinatal (pre-eclampsia, preterm delivery, macrosomia or primary cesarean section) and neonatal outcomes (birth trauma, neonatal hypoglycemia, hyperbilirubinemia or stillbirth/perinatal mortality), were analyzed by logistic regression adjusted for maternal age, pre-pregnancy body mass index, parity, socio-economic status and smoking.

Results: Of all the women, 877 (18.0%) had one, 278 (5.7%) two and 79 (1.6%) three abnormal OGTT values, while 3635 (74.7%) women were normoglycemic. Women with at least two abnormal OGTT values had higher proportions of adverse perinatal composite (35.0% vs. 27.5%, adjusted odds ratio 1.36; 95% confidence interval 1.03-1.81) and neonatal composite outcomes (31.1% vs. 18.9%, adjusted odds ratio 1.88; 95% confidence interval 1.40-2.52) compared to women with one abnormal value. The risks of delivery induction and neonatal hypoglycemia were increased regardless of the number of abnormal values when compared with normoglycemic women.

Conclusions: The risk of adverse perinatal and neonatal outcomes is significantly higher in women with two or more abnormal OGTT values than in those with one abnormal value.

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妊娠糖尿病的围产期和新生儿结局:口服葡萄糖耐量试验中异常值数量的重要性。
简介妊娠期糖尿病(GDM)的定义是口服葡萄糖耐量试验(OGTT)出现一个或多个异常值。异常值的数量对围产期和新生儿不良结局的影响/重要性尚不明确。我们在一个大型登记队列中评估了这些结果与 2 小时 75 克 OGTT 血糖异常值数量的关系:这项芬兰妊娠糖尿病研究的子研究以2009年芬兰出生医学登记册为基础,并补充了来自芬兰6家医院的4869名孕妇的OGTT实验室数据。根据芬兰指南,OGTT血浆样本的诊断临界值为≥5.3 mmol/L(空腹)、葡萄糖负荷后1小时≥10.0 mmol/L或2小时≥8.6 mmol/L。根据指南,有一个或多个 OGTT 值异常的妇女在初级保健机构接受饮食和生活方式咨询,自我监测血糖值,并根据需要接受药物治疗。患有 GDM 的妇女根据血糖值异常的次数进行分类。主要结果是围产期不良结局(先兆子痫、早产、巨大儿或初次剖宫产)和新生儿不良结局(产伤、新生儿低血糖、高胆红素血症或死产/围产期死亡)的复合结果,通过逻辑回归进行分析,并对产妇年龄、孕前体重指数、奇偶数、社会经济地位和吸烟情况进行调整:在所有产妇中,877 名(18.0%)有一次 OGTT 值异常,278 名(5.7%)有两次,79 名(1.6%)有三次,而 3635 名(74.7%)产妇血糖正常。与只有一次 OGTT 值异常的妇女相比,至少有两次 OGTT 值异常的妇女发生围产期不良综合结果(35.0% 对 27.5%,调整后的几率比 1.36;95% 置信区间 1.03-1.81)和新生儿不良综合结果(31.1% 对 18.9%,调整后的几率比 1.88;95% 置信区间 1.40-2.52)的比例更高。与血糖正常的妇女相比,无论异常值的数量多少,引产和新生儿低血糖的风险都会增加:结论:有两个或两个以上 OGTT 值异常的妇女发生围产期和新生儿不良结局的风险明显高于有一个异常值的妇女。
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来源期刊
CiteScore
8.00
自引率
4.70%
发文量
180
审稿时长
3-6 weeks
期刊介绍: Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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