Objective: To study the associations between heterogeneity of gestational diabetes mellitus (GDM) subtype/prepregnancy body mass index (pre-BMI) and large-for-gestational-age (LGA) infants of Chinese women.
Methods: We performed a retrospective case-control study of 299 women with GDM and 204 women with normal glucose tolerance (NGT), using oral glucose tolerance test-based indices performed at 24-25 weeks of gestation. Women with GDM were classified into the following three physiologic subtypes: GDM with a predominant insulin-secretion defect (GDM-dysfunction), GDM with a predominant insulin-sensitivity defect (GDM-resistance), or GDM with both defects (GDM-mixed). We then used a binary logistic regression model to evaluate the potential associations of GDM subtypes and pre-BMI with newborn macrosomia or LGA.
Results: Women with GDM-resistance had a higher pre-BMI (P < 0.001), whereas women in the GDM-dysfunction and GDM-mixed groups had pre-BMIs comparable to the NGT group. In the logistic regression model, women in the GDM-mixed group exhibited an increased risk of bearing newborns with macrosomia and LGA, and women in the GDM-dysfunction group tended to have newborns with LGA after adjusting for pre-BMI and other potential confounders. Women who were overweight or obese prepregnancy manifested an increased risk of having newborns with macrosomia and LGA relative to normal-weight women, regardless of whether values were unadjusted or adjusted for all potential confounders. There was no significant interaction between GDM subtype and pre-BMI for any of the studied outcomes.
Conclusions: Heterogeneity of GDM (GDM-dysfunction and GDM-mixed) and prepregnancy overweight/obesity were independently associated with LGA in Chinese women. There was no significant interaction between GDM subtypes and pre-BMI for LGA.
目的: 研究中国孕妇中, 妊娠期糖尿病(gestational diabetes mellitus, GDM)异质性分型及孕前体重指数分层(pre-pregnancy body mass index, pre-BMI)与大于胎龄儿(large-for-gestational-age, LGA)的关系。 方法: 我们进行了一项回顾性病例对照研究, 我们分析了299例GDM孕妇和204例正常糖耐量(normal glucose tolerance, NGT)孕妇的临床数据。诊断GDM依据妊娠第24-25周的口服糖耐量试验结果, 按照生理特征将GDM孕妇分为以下三种亚型: 以胰岛素分泌缺陷为主要特征的亚型(GDM-dysfunction, GDM-dys), 以胰岛素敏感性缺陷为主要特征的亚型(GDM-resistance, GDM-res), 或以上两种特征缺陷均具备的亚型(GDM-mixed)。使用二元logistic回归模型分析GDM亚型/pre-BMI与巨大儿或LGA的潜在关联。 结果: GDM-res组的pre-BMI较高(P < 0.001), 而GDM-dys组和GDM-mixed组与NGT组的pre-BMI相当。在logistic回归模型中, GDM-mixed组生产巨大儿和LGA的风险增加, 而校正pre-BMI和其他潜在混杂因素后, GDM-dys组生产LGA的风险也增加。与正常孕前体重的孕妇相比, 无论是否调整潜在混在因素, 孕前超重/肥胖的孕妇生产巨大儿和LGA的风险均较高。同时, 本研究未发现GDM各亚型和各pre-BMI分组之间存在显著的交互作用。 结论: 中国GDM孕妇中, 依据异质性分组, GDM-dys/GDM-mixed亚型和孕前超重/肥胖与LGA独立相关。GDM各亚型与pre-BMI各分组之间对于LGA的影响没有显著的交互作用。.
Keywords: gestational diabetes mellitus; heterogeneity; obesity; retrospective study; 回顾性研究; 妊娠期糖尿病; 异质性; 肥胖.
© 2020 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.