Starikov Roman S, Inman Kyle, Chien Edward K S, Anderson Brenna L, Rouse Dwight J, Lopes Vrishali, Coustan Donald R
Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
J Diabetes Complications. 2014 Mar-Apr;28(2):203-7. doi: 10.1016/j.jdiacomp.2013.10.004. Epub 2013 Oct 23.
To examine the association of elevated early pregnancy hemoglobin A1c (HbA1c) levels with adverse pregnancy outcomes in women with preexisting diabetes mellitus.
Retrospective cohort study of 330 women with preexisting diabetes enrolled in a Diabetes in Pregnancy Program at an academic institution between 2003 and 2011 who had an early HbA1c determination. The frequencies of composite maternal adverse pregnancy outcomes (birth at<37 weeks, preeclampsia, and medically indicated birth <39 weeks), and composite fetal adverse pregnancy outcomes [shoulder dystocia, Apgar scores<7 at 5 minutes, small for gestational age (SGA), large for gestational age (LGA), and stillbirth] were compared between HbA1c categories (<6.5, 6.5-7.4, 7.5-8.4 and ≥ 8.5%).
There was no statistically significant difference between composite adverse maternal pregnancy outcomes and composite adverse fetal pregnancy outcomes as well as other individual outcomes between different HbA1c categories. Of the vaginally delivered women in our cohort, the 37 patients with HbA1c levels of ≥ 8.5% had a significantly higher frequency of fetal shoulder dystocia than the 62 with HbA1c levels of < 8.5% (24.2 vs. 1.6%, P = 0.002). Neonates of patients with HbA1c ≥ 8.5% were more likely to have low five minute Apgar scores than neonates of patients with HbA1c < 8.5%, but this was of borderline statistical significance (7.4% vs. 0.5%, P = 0.05).
In patients with preexisting diabetes mellitus, HbA1c levels of ≥ 8.5% during early pregnancy are not useful in predicting most adverse outcomes, although there may be an increased risk for shoulder dystocia.
探讨糖尿病病史女性孕早期糖化血红蛋白（HbA1c）水平升高与不良妊娠结局之间的关联。
对2003年至2011年间在某学术机构参加妊娠糖尿病项目的330例糖尿病病史女性进行回顾性队列研究，这些女性均进行了早期HbA1c测定。比较不同HbA1c类别（<6.5%、6.5 - 7.4%、7.5 - 8.4%和≥8.5%）之间孕产妇不良妊娠复合结局（孕37周前分娩、子痫前期和孕39周前医学指征分娩）以及胎儿不良妊娠复合结局[肩难产、5分钟时阿氏评分<7分、小于胎龄儿（SGA）、大于胎龄儿（LGA）和死产]的发生频率。
不同HbA1c类别之间孕产妇不良妊娠复合结局、胎儿不良妊娠复合结局以及其他个体结局在统计学上均无显著差异。在我们队列中经阴道分娩的女性中，HbA1c水平≥8.5%的37例患者胎儿肩难产的发生频率显著高于HbA1c水平<8.5%的62例患者（24.2%对1.6%，P = 0.00）。HbA1c≥8.5%患者的新生儿5分钟阿氏评分低的可能性高于HbA1c<8.5%患者的新生儿，但这具有边缘统计学意义（7.4%对0.5%，P = 0.05）。
对于糖尿病病史女性，孕早期HbA1c水平≥8.5%对预测大多数不良结局并无帮助，尽管肩难产风险可能增加。
