Rafat Dalia, Ahmad Jamal
Department of Obstetrics and Gynecology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India.
Diabetes Metab Syndr. 2012 Jan-Mar;6(1):59-64. doi: 10.1016/j.dsx.2012.05.010. Epub 2012 Jun 30.
During pregnancy, the glucose levels vary according to the hormonal changes and the metabolic needs necessary to maintain fetal nutrition but strict glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by diabetes. Although considered the "gold standard" for diagnosis, measurement of glucose in the blood is subject to several limitations, many of which are not widely appreciated. Measurement of A1c for diagnosis is appealing as with one number, a total, integrated view of glycemia over time is derived though it has some inherent limitations. Thus, supplementation with HbA1c, as is common outside pregnancy, seems appropriate. Before pregnancy, the target for metabolic control in women with diabetes is HbA1c values near the normal range. However, the upper normal range of HbA1c during normal pregnancy is only sparsely investigated with different methods though recently a number of papers have been published regarding the determination of reference ranges for HbA1c in pregnancy. These changes may have clinical implications for the assessment and management of glycemic control in diabetic pregnancy and calls for establishment of separate reference limits of HbA1c levels in different trimesters as compared to general population.
在怀孕期间，血糖水平会根据激素变化以及维持胎儿营养所需的代谢需求而有所不同，但严格控制血糖对于将糖尿病合并妊娠的母婴发病率和死亡率降至最低至关重要。尽管血糖检测被认为是诊断的“金标准”，但其存在一些局限性，其中许多并未得到广泛认识。糖化血红蛋白（A1c）检测用于诊断很有吸引力，因为通过一个数值就能得出一段时间内血糖的总体综合情况，不过它也有一些固有局限性。因此，像孕期外常见的那样补充糖化血红蛋白检测似乎是合适的。怀孕前，糖尿病女性的代谢控制目标是糖化血红蛋白值接近正常范围。然而，尽管最近有一些关于孕期糖化血红蛋白参考范围测定的论文发表，但正常孕期糖化血红蛋白的正常上限范围仅通过不同方法进行了少量研究。这些变化可能对糖尿病妊娠血糖控制的评估和管理具有临床意义，因此需要建立与普通人群相比不同孕期糖化血红蛋白水平的单独参考限值。
