Treatment of women with mild gestational diabetes mellitus decreases the risk of adverse perinatal outcomes

IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Fanny Goyette , Bi Lan Wo , Marie-Hélène Iglesias , Evelyne Rey , Ariane Godbout
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引用次数: 0

Abstract

Aims

Glycemic thresholds used to diagnose gestational diabetes mellitus (GDM) are a continued subject of debate. Lower glycemic thresholds identify women with milder GDM for whom treatment benefit is unclear. We compared adverse maternal and neonatal outcomes in treated and untreated women with mild hyperglycemia.

Methods

We reviewed 11 553 patient charts from two tertiary care centers and included singleton pregnancies >32-week gestation. GDM was diagnosed using the one- or two-step 75 g oral glucose tolerance test (OGTT) depending on the center. All OGTT results were reviewed. Women with glycemic values falling between the thresholds of the two tests, referred to as intermediate hyperglycemic (IH), defined as FPG 5.1–5.2 mmol/L, 1 h PG 10.0–10.5 mmol/L, or 2 h PG 8.5–8.9 mmol/L at 75 g OGTT, were untreated at center A and treated at center B.

Results

There were 630 women with IH, 334 were untreated (center A) and 296 who were treated (center B). After adjusting for covariates, untreated IH women had significantly higher rates of gestational hypertension (aOR 6.02, P = 0.002), large for gestational age (LGA) (aOR 3.73, P < 0.001) and birthweights > 4000 g (aOR 3.35, P = 0.001). Our results indicate that treating 11 women with IH would prevent one LGA birth and treating 13 would prevent 1 birthweight > 4000 g.

Conclusion

The diagnosis of GDM using the two-step OGTT fails to identify subgroups of women with mild hyperglycemia that would benefit from treatment to lower the risk for adverse maternal and neonatal outcomes. Treatment of women with mild hyperglycemia decreased the risk of LGA and birthweight >4000 g by 3-fold.

治疗轻度妊娠期糖尿病妇女可降低不良围产期结局的风险
用于诊断妊娠期糖尿病(GDM)的血糖阈值一直是争论的主题。低血糖阈值可确定患有轻度GDM的女性,其治疗益处尚不清楚。我们比较了轻度高血糖患者接受治疗和未接受治疗的产妇和新生儿的不良结局。方法我们回顾了来自两个三级护理中心的11553名患者的病历,包括单胎妊娠>;妊娠32周。根据中心的不同,使用一次或两次75g口服葡萄糖耐量试验(OGTT)诊断GDM。对所有OGTT结果进行了审查。血糖值在两项测试阈值之间的女性,称为中度高血糖(IH),定义为FPG 5.1–5.2 mmol/L、1小时PG 10.0–10.5 mmol/L或2小时PG 8.5–8.9 mmol/L,在75 g OGTT下,在A中心未治疗,在B中心治疗。结果有630名IH女性,334名未治疗(A中心),296名接受治疗(B中心)。在校正协变量后,未经治疗的IH妇女的妊娠期高血压发生率显著较高(aOR 6.02,P=0.002),胎龄大(LGA)发生率(aOR 3.73,P<;0.001),出生体重>;4000克(aOR 3.35,P=0.001)。我们的结果表明,用IH治疗11名妇女将预防一次LGA分娩,而治疗13名妇女将防止一次出生体重>;结论使用两步OGTT对GDM的诊断未能确定患有轻度高血糖的女性亚组,这些亚组将受益于降低孕产妇和新生儿不良结局风险的治疗。对患有轻度高血糖的妇女的治疗降低了LGA和出生体重的风险>;4000克乘3倍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetes & metabolism
Diabetes & metabolism 医学-内分泌学与代谢
CiteScore
12.00
自引率
4.20%
发文量
86
审稿时长
13 days
期刊介绍: A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.
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