关键词: 妊娠期, 空腹血糖, 胎儿腹围, 发展轨迹

Abstract: Objective To investigate the longitudinal trajectories of fasting plasma glucose (FPG) during pregnancy and elucidate their association with fetal abdominal circumference, thereby providing a theoretical foundation for optimal glycemic management in the perinatal period. Methods Pregnant women who received routine prenatal care and subsequently delivered at Suqian Hospital, Affiliated with Jiangsu Province Hospital, between August 2023 and January 2025 were recruied. FPG levels were quantified, and fetal abdominal circumference was assessed via ultrasonography at four critical time points: 12 gestational weeks (T0), 24-28 weeks (T1), 34-37 weeks (T2), and within 24 hours prior to delivery (T3). Latent growth mixture modeling (LGMM) was employed to identify unobserved subpopulations with distinct FPG developmental trajectories. Subsequently, a linear mixed-effects model was utilized to analyze the association between these trajectory classes and the fetal abdominal circumference Z-score, adjusting for potential confounders including pre-pregnancy body mass index (BMI), maternal age, parity, and familial history of diabetes. Results The final analysis included a cohort of 226 pregnant women, with an overall loss to follow-up rate of 1.74%. Four discrete FPG developmental trajectories were identified: persistently high (17.7%), high-decreasing (23.9%), low-increasing (15.0%), and persistently low (43.4%). Statistically significant heterogeneity was observed across the four classes regarding pre-pregnancy BMI and the prevalence of a familial history of diabetes (P<0.05). Following adjustment for confounding variables, a robust interaction effect between the FPG trajectory class and time on the fetal abdominal circumference Z-score was detected (P<0.001). The velocity of fetal abdominal circumference growth in both the persistently high and low-increasing classes was significantly accelerated compared to the persistently low class (slope differences of 0.31 and 0.25, respectively, both P<0.001), whereas the growth trajectory in the high-decreasing class exhibited a trend toward normalization. Conclusion The maternal population manifests four distinct developmental trajectories of FPG during pregnancy. The persistently high and low-increasing trajectories constitute high-risk phenotypic patterns for excessive fetal abdominal circumference growth. It is imperative that clinical practitioners implement intensified glycemic monitoring and targeted management strategies for pregnant women exhibiting these specific glycemic profiles.

Key words: Pregnancy, Fasting plasma glucose, Fetal abdominal circumference, Development trajectories