监测妊娠糖尿病和糖耐量正常妇女的胎儿大小。

IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Acta Diabetologica Pub Date : 2024-07-20 DOI:10.1007/s00592-024-02330-0
Kaat Beunen, Frederik Van den Abbeele, Paul Van Crombrugge, Johan Verhaeghe, Sofie Vandeginste, Hilde Verlaenen, Toon Maes, Els Dufraimont, Nele Roggen, Christophe De Block, Yves Jacquemyn, Farah Mekahli, Katrien De Clippel, Annick Van den Bruel, Anne Loccufier, Annouschka Laenen, Roland Devlieger, Chantal Mathieu, Katrien Benhalima
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引用次数: 0

摘要

目的:监测妊娠期糖尿病(GDM)和糖耐量正常(NGT)妇女的胎儿大小,并确定出生体重的预测因素:方法:对 1843 名妊娠期糖尿病(GDM)妇女进行队列研究,每三个月进行一次常规超声波检查。按出生体重百分位数对 GDM 和 NGT 妇女进行分组:结果:在所有孕妇中,有 231 名(12.5%)被确诊为 GDM。胎儿大小、大胎龄新生儿(LGA:GDM 12.3%,NGT 12.9%,P = 0.822)和小胎龄新生儿(SGA)的发生率(GDM 4.8%,NGT 5.1%,P = 0.886)在 GDM 和 NGT 之间相似。与有 AGA(适宜胎龄)新生儿的 GDM 妇女相比,有 LGA 新生儿的 GDM 妇女在基线时胰岛素抵抗更强,在 28-33 周超声波检查中估计胎儿体重(EFW)≥ P90 的频率更高(p = 0.033)。与有 AGA 新生儿的 NGT 妇女相比,有 LGA 新生儿的妇女更常见于肥胖和多产,空腹血糖更高,血脂状况更差,在 24-28 周期间胰岛素抵抗更高,妊娠体重增加过多的情况更常见。在28-33周的超声检查中,腹围≥P95对GDM中的LGA新生儿有很高的阳性预测值(100%),而在GDM和NGT中,EFW≥P90和≤P10对LGA和SGA新生儿分别有很高的阴性预测值(> 88%):GDM 和 NGT 孕妇在整个孕期的胎儿大小和 LGA 发生率方面没有差异。28-33周的EFW百分位数与出生体重有很好的相关性。这表明GDM治疗是有效的,有针对性的超声波随访也是有用的。试验注册 clinicaltrials.gov:NCT02036619。注册日期:2014 年 1 月 15 日。https://clinicaltrials.gov/ct2/show/NCT02036619 。
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Fetal size monitoring in women with gestational diabetes and normal glucose tolerance.

Aims: To monitor fetal size and identify predictors for birthweight in women with gestational diabetes (GDM) and normal glucose tolerance (NGT).

Methods: Cohort study of 1843 women universally screened for GDM, with routine ultrasounds each trimester. Women with GDM and NGT were categorized in subgroups by birthweight centile.

Results: Of the total cohort, 231 (12.5%) women were diagnosed with GDM. Fetal size, incidence of large-for-gestational age (LGA: 12.3% of GDM vs. 12.9% of NGT, p = 0.822) and small-for-gestational age (SGA) neonates (4.8% of GDM vs. 5.1% of NGT, p = 0.886) were similar between GDM and NGT. GDM women with LGA neonates were more insulin resistant at baseline and had more often estimated fetal weight (EFW) ≥ P90 on the 28-33 weeks ultrasound (p = 0.033) than those with AGA (appropriate-for-gestational age) neonates. Compared to NGT women with AGA neonates, those with LGA neonates were more often obese and multiparous, had higher fasting glycemia, a worse lipid profile, and higher insulin resistance between 24 -28 weeks, with more often excessive gestational weight gain. On the 28-33 weeks ultrasound, abdominal circumference ≥ P95 had a high positive predictive value for LGA neonates in GDM (100%), whereas, in both GDM and NGT, EFW ≥ P90 and ≤ P10 had a high negative predictive value for LGA and SGA neonates (> 88%), respectively.

Conclusions: There were no differences in fetal size throughout pregnancy nor in LGA incidence between GDM and NGT women. EFW centile at 28-33 weeks correlated well with birthweight. This indicates that GDM treatment is effective and targeted ultrasound follow-up is useful. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02036619. Registration date: January 15, 2014. https://clinicaltrials.gov/ct2/show/NCT02036619 .

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来源期刊
Acta Diabetologica
Acta Diabetologica 医学-内分泌学与代谢
CiteScore
7.30
自引率
2.60%
发文量
180
审稿时长
2 months
期刊介绍: Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.
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