Cyganek Katarzyna, Skupien Jan, Katra Barbara, Hebda-Szydlo Alicja, Janas Izabela, Trznadel-Morawska Iwona, Witek Przemysław, Kozek Elżbieta, Malecki Maciej T
Department of Metabolic Diseases, University Hospital, Krakow, Poland.
Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
Endocrine. 2017 Feb;55(2):447-455. doi: 10.1007/s12020-016-1134-z. Epub 2016 Oct 11.
Macrosomia risk remains high in type 1 diabetes (T1DM) complicated pregnancies. A linear relationship between macrosomia risk and glycated hemoglobin A (HbA) was described; however, low range of HbA has not been studied. We aimed to identify risk factors and examine the impact of HbA on the occurrence of macrosomia in newborns of T1DM women from a cohort with good glycemic control. In this observational retrospective one-center study we analyzed records of 510 consecutive T1DM pregnancies (1998-2012). The analyzed group consisted of 375 term singleton pregnancies. We used multiple regression models to examine the impact of HbA and self-monitored glucose in each trimester on the risk of macrosomia and birth weight. The median age of T1DM women was 28 years, median T1DM duration-11 years, median pregestational BMI-23.3 kg/m. Median birth weight reached 3520 g (1st and 3rd quartiles 3150 and 3960, respectively) at median 39 weeks of gestation. There were 85 (22.7 %) macrosomic (>4000 g) newborns. Median HbA levels in the 1st, 2nd, and 3rd trimester were 6.4, 5.7, and 5.6 %. Third trimester HbA, mean fasting self-monitored glucose and maternal age were independent predictors of birth weight and macrosomia. There was a linear relationship between 3rd trimester HbA and macrosomia risk in HbA range from 4.5 to 7.0 %. Macrosomia in children of T1DM mothers was common despite excellent metabolic control. Glycemia during the 3rd trimester was predominantly responsible for this condition.
1型糖尿病（T1DM）合并妊娠时巨大儿风险仍然很高。已有研究描述了巨大儿风险与糖化血红蛋白A（HbA）之间的线性关系；然而，HbA低水平范围尚未得到研究。我们旨在确定来自血糖控制良好队列的T1DM女性新生儿巨大儿发生的风险因素，并研究HbA对其的影响。在这项单中心观察性回顾性研究中，我们分析了510例连续的T1DM妊娠（1998 - 2012年）记录。分析组包括375例足月单胎妊娠。我们使用多元回归模型来研究各孕期HbA和自我监测血糖对巨大儿风险和出生体重的影响。T1DM女性的中位年龄为28岁，T1DM病程中位值为11年，孕前BMI中位值为23.3kg/m²。妊娠39周时出生体重中位数达到3520g（第一和第三四分位数分别为3150和3960）。有85例（22.7%）巨大儿（>4000g）新生儿。孕早期、孕中期和孕晚期的HbA中位数水平分别为6.4%、5.7%和5.6%。孕晚期HbA、平均空腹自我监测血糖和母亲年龄是出生体重和巨大儿的独立预测因素。在HbA范围为4.5%至7.0%时孕晚期HbA与巨大儿风险之间存在线性关系。尽管代谢控制良好，TIDM母亲的孩子中巨大儿仍很常见。孕晚期血糖是导致这种情况的主要原因。
