基于孕前体重指数的早孕期空腹血浆葡萄糖水平预测妊娠期糖尿病的价值

Early pregnancy fasting plasma glucose levels based on pre-pregnancy body mass index as a predictor of gestational diabetes mellitus

目的探讨不同孕前体重指数(pre-pregnancy body mass index,pre-BMI)孕妇早孕期(孕8~12周)空腹血浆葡萄糖(fasting plasma glucose,FPG)水平预测妊娠期糖尿病(gestational diabetes mellitus,GDM)的价值及临床意义。方法回顾性纳入2020年1月至2022年12月在余姚市人民医院产前检查并分娩的早孕期FPG≤5.6 mmol/L的单胎妊娠孕妇9710例,根据pre-BMI分层,分别为<18.5(n=1406)、≥18.5~<25.0(n=7162)、≥25.0~<30.0(n=978)及≥30.0 kg/m2(n=164)。同一pre-BMI分层孕妇,按早孕期FPG分为4组(<4.5、≥4.5~<4.8、≥4.8~<5.1及≥5.1 mmol/L)。运用单因素分析及多因素logistic回归分析发生GDM的危险因素,并根据pre-BMI进行分层分析,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估早孕期FPG预测GDM的效能。结果早孕期FPG≤5.6 mmol/L的单胎妊娠孕妇GDM发生率为12.3%(1197/9710)。pre-BMI<18.5 kg/m2时,早孕期FPG<4.5、≥4.5~<4.8、≥4.8~<5.1和≥5.1 mmol/L的孕妇发生GDM的OR值(95%CI)分别为0.041(0.015~0.409)、1.834(1.089~3.088)、6.779(4.041~11.371)和13.723(5.560~33.871);pre-BMI≥18.5~<25.0 kg/m2时,分别为0.048(0.012~0.203)、2.573(2.091~3.168)、9.023(7.240~11.245)和9.158(6.484~12.937);pre-BMI≥25.0~<30.0 kg/m2时,分别为0.108(0.053~0.446)、1.698(1.064~2.654)、7.537(5.285~13.080)和9.994(5.613~18.218);BMI≥30.0 kg/m2时,分别为0.098(0.072~1.015)、2.888(0.911~9.157)、13.674(3.480~53.736)和20.509(6.674~63.019)。全体孕妇中,早孕期FPG预测GDM的最佳界值为4.7 mmol/L,曲线下面积为0.752,早孕期FPG≥4.7 mmol/L时发生GDM的风险升高(OR=17.356,95%CI:13.757~21.896,P<0.001)。结论早孕期FPG≤5.6 mmol/L的单胎妊娠孕妇中,早孕期FPG是GDM发生的独立危险因素;同一pre-BMI分层孕妇,随着早孕期FPG的升高,其发生GDM的风险逐渐升高。早孕期FPG对预测GDM发生具有一定价值。

Objective To investigate the value and clinical significance of fasting plasma glucose(FPG)in early pregnancy(8-12 gestational weeks)as a predictor of gestational diabetes mellitus(GDM)among women with different pre-pregnancy body mass index(pre-BMI)categories.Methods A retrospective study was conducted including 9710 singleton pregnant women(FPG levels in early pregnancy≤5.6 mmol/L)who underwent prenatal screening and delivery in Yuyao People's Hospital from January 2020 to December 2022.Participants were stratified based on their pre-BMI as follows:<18.5(n=1406),≥18.5 to<25.0(n=7162),≥25.0 to<30.0(n=978),and≥30.0 kg/m2(n=164).Within each pre-BMI category,women were further divided into four groups based on FPG levels in early pregnancy(<4.5,≥4.5 to<4.8,≥4.8 to<5.1,and≥5.1 mmol/L).Univariate and multivariate logistic regression analysis were used to identify risk factors for GDM,and receiver operating characteristic(ROC)curve was applied to evaluate the efficacy of FPG in early pregnancy based on different pre-BMI in predicting GDM.Results The overall incidence of GDM in the singleton pregnancy women with FPG levels in early pregnancy≤5.6 mmol/L was 12.3%(1197/9710).For a pre-BMI of<18.5 kg/m2,the ORs with 95%CIs for GDM within the different FPG categories(<4.5,≥4.5 to<4.8,≥4.8 to<5.1,and≥5.1 mmol/L)were 0.041(95%CI:0.015-0.409),1.834(95%CI:1.089-3.088),6.779(95%CI:4.041-11.371),and 13.723(95%CI:5.560-33.871),respectively.For pre-BMI of≥18.5 to<25.0 kg/m2,the respective the ORs with 95%CIs were 0.048(95%CI:0.012-0.203),2.573(95%CI:2.091-3.168),9.023(95%CI:7.240-11.245),and 9.158(95%CI:6.484-12.937).For pre-BMI of≥25.0 to<30.0 kg/m2,the ORs with 95%CIs were 0.108(95%CI:0.053-0.446),1.698(95%CI:1.064-2.654),7.537(95%CI:5.285-13.080),and 9.994(95%CI:5.613-18.218).For pre-BMI of≥30.0 kg/m2,the ORs with 95%CIs were 0.098(95%CI:0.072-1.015),2.888(95%CI:0.911-9.157),13.674(95%CI:3.480-53.736),and 20.509(95%CI:6.674-63.019).The optimal cutoff value of FPG in early pregnancy for GDM prediction was 4.7 mmol/L with an area under the curve of 0.752,the risk of GDM significantly increased with FPG levels≥4.7 mmol/L in early pregnancy across all pregnant women(OR=17.356,95%CI:13.757-21.896,P<0.001).Conclusions In the singleton pregnancy women with FPG levels in early pregnancy≤5.6 mmol/L,FPG in early pregnancy is an independent risk factor for the occurrence of GDM;for pregnant women stratified by the same pre-BMI,the risk of developing GDM increases progressively with the rise of FPG in early pregnancy.FPG in early pregnancy has a certain value in predicting the occurrence of GDM.