匈牙利普遍筛查识别的妊娠期糖尿病趋势：基于人群的观察性研究
本研究基于匈牙利托尔瑙县2010至2017年所有单胎妊娠的普遍筛查数据，纳入7071例在孕24–28周完成75g OGTT且≥24周分娩的孕妇。结果显示妊娠期糖尿病患病率从15%升至20%，空腹、1小时和2小时血糖均上升。校正模型提示孕早期至OGTT时的BMI增加是GDM流行的更重要决定因素。
要点
- 匈牙利该地区GDM患病率2010至2017年从15%升至20%。
- OGTT时BMI的上升趋势可解释GDM诊断增加的25%–30%。
- 预防GDM应同时关注孕前BMI和孕早期至中期的体重增加。
核心结论
- 匈牙利该地区妊娠期糖尿病患病率在2010至2017年间显著上升，从15%增至20%。
- 孕早期至OGTT时的BMI增加比孕早期BMI更能解释GDM的流行趋势。
研究设计与样本
- 基于匈牙利托尔瑙县2010至2017年普遍筛查项目的横断面观察性研究。
- 研究对象为该地区所有单胎妊娠，孕24–28周完成3点75g OGTT，纳入≥24周分娩且协变量完整者共7071例，占合格人群的88.4%。
主要发现
- GDM患病率每年增加5%（95%CI：4%–6%），从2010年的15%升至2017年的20%。
- 空腹血糖增加0.1mmol/L（95%CI：0.08–0.12），1小时血糖增加0.5mmol/L（95%CI：0.4–0.6），2小时血糖增加0.2mmol/L（95%CI：0.1–0.3）。
- 校正OGTT时BMI后，BMI上升趋势可解释GDM诊断和空腹血糖增加的25%–30%，解释1小时血糖增加的12%，对2小时血糖无统计学意义。
关键数值与推荐
- GDM诊断采用WHO-2013诊断标准，筛查方法为孕24–28周3点75g OGTT。
- 纳入分析者需有完整协变量和3点OGTT结果，且分娩孕周≥24周。
临床怎么用
- 预防GDM进一步上升应同时针对孕前BMI和孕早期至中期的体重增加进行干预。
- 临床应重视OGTT时BMI的变化，而不仅关注孕早期BMI。
局限性
- 协变量在分娩后收集，可能存在回忆偏倚。
- 研究局限于匈牙利一个县的人群，外推至其他人群需谨慎。
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
ABSTRACT 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
- BJOG：Trends in Gestational Diabetes Identified through Universal Screening: A Population‐Based Observational Study
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。