怀孕期间葡萄糖在范围轨迹中的时间和与不良围产期结果的关联:一种联合潜伏类轨迹建模方法
Sara M Sauer1, Isabel Fulcher2, Ayodeji Sanusi3
1Delfina Care, San Francisco, CA (Sauer and Fulcher); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (Sauer).
American journal of obstetrics & gynecology MFM
|March 17, 2025
概括
了解怀孕期间葡萄糖时间范围 (TIR) 轨迹对于管理糖尿病至关重要. 特定的TIR模式与早产,新生儿重症监护室 (NICU) 住院和孕期大婴儿 (LGA) 的风险增加有关.
科学领域:
- 产科和妇科 产科和妇科
- 内分泌学 在内分泌学.
- 围产儿医学 围产儿医学
背景情况:
- 怀孕期间的时间范围 (TIR) 与先前存在的1型或2型糖尿病的不良结果有关.
- 跨妊娠期演变的TIR对怀孕结果的影响尚不清楚.
研究的目的:
- 在整个怀孕期间识别不同的葡萄糖TIR轨迹.
- 评估这些TIR轨迹与先前存在糖尿病患者的围产期结局之间的关联.
主要方法:
- 用连续血糖监测 (CGM) 对179名患有1型或2型糖尿病的孕妇进行了回顾性队列研究.
- 每周的TIR (65-140 mg/dL) 从怀孕10周开始计算.
- 联合潜伏类轨迹建模确定了四个TIR组.
- 多变量逻辑回归分析了与围产期结局的关联.
主要成果:
- 确定了四种TIR轨迹:稳定的良好控制,中度与晚期下降,中度与晚期改善,以及晚期改善的差.
- 低于最佳的早期怀孕TIR (组2,3,4) 与更高的早产,预示早产和NICU入院的几率相关.
- 最低的第二/第三季度初TIR (组3,4) 与孕期大婴儿 (LGA) 的几率增加有关.
- 第4组也显示出更高的孕前和新生儿低血糖的几率.
结论:
- 在第二个和第三个月初的血糖控制对于减少不良妊娠结果,特别是LGA,至关重要.
- 第三个三个月的TIR下降可能会增加早产和NICU入院的风险.
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