通过普遍筛查识别的妊娠期糖尿病趋势：一项基于人群的观察性研究
该研究基于匈牙利Tolna县2010-2017年所有单胎妊娠的横断面普遍筛查数据（n=7071），采用75g口服葡萄糖耐量试验（OGTT）在孕24-28周诊断妊娠期糖尿病（GDM）。结果显示GDM患病率从15%升至20%，空腹、1小时和2小时负荷后血糖均上升，且OGTT时BMI的日历趋势可解释GDM诊断和空腹血糖增加的25%-30%。
要点
- 2010-2017年匈牙利GDM患病率从15%增至20%，年均增加5%。
- 空腹、1小时和2小时负荷后血糖分别平均上升0.1、0.5和0.2 mmol/L。
- OGTT时BMI升高可解释GDM和空腹血糖增加的25%-30%，提示孕期BMI增长比孕早期BMI更重要。
核心结论
- 孕期前两个三个月的BMI增长比孕早期BMI对匈牙利GDM流行更重要，预防GDM需同时针对两者。
研究设计与样本
- 基于人群的横断面普遍筛查研究，纳入2010-2017年匈牙利Tolna县所有单胎妊娠，最终分析7071例（占符合条件者的88.4%），于孕24-28周行3点75g OGTT。
主要发现
- GDM患病率从2010年的15%上升至2017年的20%，增加5%（95%CI：4%-6%）。
- 空腹血糖平均上升0.1 mmol/L（95%CI 0.08-0.12），1小时负荷后血糖上升0.5 mmol/L（95%CI 0.4-0.6），2小时负荷后血糖上升0.2 mmol/L（95%CI 0.1-0.3）。
- 完全调整模型（包括两种BMI测量）中，OGTT时BMI的日历趋势可解释GDM诊断和空腹血糖增加的25%-30%，1小时血糖增加的12%，2小时血糖增加不显著。
关键数值与推荐
- GDM诊断采用WHO-2013标准。
- 筛查方法为孕24-28周行3点75g OGTT。
临床怎么用
- 临床应关注孕期BMI增长，而不仅是孕早期BMI，以预防GDM。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To explore trends of gestational diabetes (GDM) prevalence, as well as fasting, 1 h and 2 h post-load glucose and its determinants in Hungary between 2010 and 2017. DESIGN: Cross-sectional universal screening programme for GDM (3-point 75 g OGTT at 24-28 weeks of gestation). SETTING: Tolna County (South-Western Hungary). POPULATION: All singleton pregnancies between 2010 and 2017. METHODS: Participants with available co-variables (including 3-point OGTT) and deliveries ≥ 24 weeks of gestation were included (n = 7071, 88.4% of those eligible). Exposures (known GDM risk factors) were collected after delivery including BMI at early-pregnancy and at OGTT. MAIN OUTCOME MEASURES: Time trends of GDM occurrence (WHO-2013 diagnostic criteria) and fasting, 1 h, and 2 h post-load glucose. Analyses were done with multiple logistic and linear regression. RESULTS: The prevalence of GDM increased by 5% (95% CI: 4%-6%) from 15% to 20% between 2010 and 2017. Fasting, 1 h, and 2 h post-load glucose increased by 0.1 (95% CI 0.08-0.12), 0.5 (95% CI 0.4-0.6) and 0.2 (95% CI 0.1-0.3) mmol/l, respectively. On the basis of fully adjusted models including both BMI measures, a significant proportion (25%-30%) of this increase for GDM diagnosis and for fasting glucose was explained by increasing calendar trend in BMI measured at the OGTT. Smaller proportions of 1 h (12%) and 2 h (NS) post-load glucose were explained by BMI changes. CONCLUSIONS: Our finding suggests that BMI-gain during the first two trimesters of pregnancy is a more important determinant of the GDM epidemic in Hungary than early-pregnancy BMI. To prevent the further increase in the prevalence of GDM, both factors should be targeted.
引用
- Panykó I, Kun A, Visolyi GÁ, et al. Trends in Gestational Diabetes Identified through Universal Screening: A Population-Based Observational Study. BJOG. 2026. PMID: 42115700. doi:10.1111/1471-0528.70261
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。