2023年 · 第05卷第01期

To build a reference fetal growth chart for the Chinese population based on fetal ultrasound measurements.

This was a multicenter, population-based retrospective cohort study. Longitudinal ultrasound measurement data were collected from 24 hospitals in 18 provinces of China from 1^st September through 31^st October of 2019. The estimated fetal weight (EFW) was calculated based on head circumference, abdominal circumference, and femur length using Hadlock formula 3. Fetal growth curves were estimated using a two-level linear regression model with cubic splines. All participants were divided into two groups: the northern group (n = 5829) and the southern group (n = 3246) based on the geographical division of China and male fetus group (n = 4775) and female fetus group (n = 4300) based on fetal gender. The EFW was compared by fetal gender and geographical group. All statistical models were adjusted for maternal sociodemographic characteristics.

A total of 9075 participants with 31,700 ultrasound measurement records were included in this study. Male fetuses demonstrated significantly larger EFW compared to female ones starting at 16 weeks of gestation and extending to delivery (global test P < 0.01). The overall geographic difference in EFW was significant (global test P = 0.03), and week-specific comparisons showed that the northern group had a greater EFW starting at 15 weeks of gestation and extending to 29 weeks of gestation, although this difference did not extend to the time of delivery. The Z-score of EFW confirmed that our Chinese fetal growth charts differed from previously published standards.

This study provides EFW and ultrasound biometric reference measurements for Chinese fetuses and reveals differences from other fetal growth charts. The chart is worth promoting in more regions of China but should be tested prudently before use.

This study aimed to determine the likelihood of gestational diabetes mellitus (GDM) in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.

This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018. Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further. Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy, and the characteristics and GDM risk of these groups were compared. A univariate analysis of potential risk factors was performed using the Chi-squared test and/or t-test for qualitative or quantitative variables, respectively. Associations with P values <0.1 were chosen to be included in the multivariate binary logistic regression model.

In primary analysis of 6204 women, the incidence of GDM in subsequent pregnancy is 48.9% (490/1002) in women with GDM history and 16.1% (835/5202) in women without GDM history. In a further analysis for 5180 women without GDM at index pregnancy, compared with the non-GDM group, the GDM group had a significantly higher age, prepregnancy body mass index, and blood glucose value at each oral glucose tolerance test (OGTT) timepoint (fasting, 1 h and 2 h) during the index and subsequent pregnancies, as well as higher weight retention during the interval between the two pregnancies (P<0.001). Age above 35 years in subsequent pregnancy (odds ratio (OR)=1.540, 95% confidence interval (CI) = 1.257-1.886, P<0.001), macrosomia in index pregnancy (OR=1.749, 95% CI=1.277-2.395, P=0.001), OGTT blood glucose values in index pregnancy (fasting, OR=2.487, 95% CI=1.883-3.285, P<0.001; 1 h, OR=1.142, 95% CI=1.051-1.241, P=0.002; 2 h, OR=1.290, 95% CI=1.162-1.432, P<0.001) and weight retention (OR=1.052, 95% CI=1.035-1.068, P<0.001) were independent risk factors for GDM in subsequent pregnancy.

For women without GDM history, GDM risk factors including age, macrosomia history, OGTT value, and weight retention, these can be evaluated before a subsequent pregnancy. Early warning and interventions are needed for women at high risk.

Gestational diabetes mellitus (GDM) is a specific disease during pregnancy that is characterized by the onset of abnormal maternal glucose tolerance,¹which was first discovered by O’Sullivan and Mahan²in 1964. Since then, the gradual understanding of the impact of GDM on the long-term risk of maternal diabetes and other metabolic diseases has led to modifications in the diagnostic criteria of GDM by different associations and organizations. The American National Diabetes Data Group³and the American Diabetes Association⁴both recommended a 50-g glucose challenge test before the 100 g/75 g oral glucose tolerance test (OGTT), forming the rudiment of a "two-step" screening strategy for GDM. A revolutionary transformation in GDM diagnostic criteria occurred in 2008, following the publication of the hyperglycemia and adverse pregnancy outcome (HAPO) study. This long-term observational study of 25,505 nonovert diabetes singleton pregnancies from 15 centers of nine countries explored the relationship between hyperglycemia and the adverse perinatal outcomes. A continuous positive linear association between hyperglycemia and adverse perinatal outcomes was observed, whether the glucose level was measured categorically or continuously. This demonstrated that, besides the long-term impact of GDM on maternal metabolism, GDM directly impacted the gestational process as well, especially in increasing the fetal weight and the C-peptide levels of the umbilical cord. The fetal birthweight increased from 240 to 300 g with the lowest to the highest glucose category, while the adjusted odds ratio increased from 1.37 to 5.01 and 1.41 to 7.65, respectively, for the risk of large-for-gestational-age (LGA) infant and cord-blood serum levels of C-peptide.⁵In view of these findings, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed a new GDM diagnostic criteria. The IADPSG recommended a "one-step" approach for screening, with the threshold based on a 1.75-fold risk of developing neonatal macrosomia, which was much lower than the previous diagnostic standards.⁶This proposal was accepted by many global organizations, including the World Health Organizations⁷and the International Federation of Obstetrics and Gynecology,⁸and was widely used in different countries including China, aiming to reduce the risk of LGA, cesarean delivery (CD), and other adverse perinatal outcomes. However, other experts expressed concern over adopting this approach, arguing that it was not well understood how the additionally identified patients with GDM would benefit from the treatment, especially weighing the consequent financial costs, workload of the health service (more intensive maternal and fetal assessments), and the psychological burden when labeling individuals as GDM patients.⁹Furthermore, there were concerns as to whether there was sufficient high-quality evidence proving that one approach could replace all the other approaches and be popularized worldwide.

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Following the original article’s publication,¹the authors identified an error in the published version.