Sweeting Arianne N, Ross Glynis P, Hyett Jon, Molyneaux Lynda, Tan Kris, Constantino Maria, Harding Anna Jane, Wong Jencia
Diabetes Centre.
Sydney Medical School and.
J Clin Endocrinol Metab. 2017 Jan 1;102(1):150-156. doi: 10.1210/jc.2016-2951.
The increasing prevalence of gestational diabetes mellitus (GDM) necessitates risk stratification directing limited antenatal resources to those at greatest risk. Recent evidence demonstrates that an early pregnancy glycated hemoglobin (HbA1c ≥5.9% (41 mmol/mol) predicts adverse pregnancy outcomes.
To determine the optimal HbA1c threshold for adverse pregnancy outcomes in GDM in a treated multiethnic cohort and whether this differs in women diagnosed <24 vs ≥24 weeks' gestation (early vs standard GDM).
This was a retrospective cohort study undertaken at the Royal Prince Alfred Hospital Diabetes Antenatal Clinic, Australia, between 1991 and 2011.
Pregnant women (N = 3098) underwent an HbA1c (single-laboratory) measurement at the time of GDM diagnosis. Maternal clinical and pregnancy outcome data were collected prospectively.
The association between baseline HbA1c and adverse pregnancy outcomes in early vs standard GDM.
HbA1c was measured at a median of 17.6 ± 3.3 weeks' gestation in early GDM (n = 844) and 29.4 ± 2.6 weeks' gestation in standard GDM (n = 2254). In standard GDM, HbA1c >5.9% (41 mmol/mol) was associated with the greatest risk of large-for-gestational-age (odds ratio [95% confidence interval] = 2.7 [1.5-4.9]), macrosomia (3.5 [1.4-8.6]), cesarean section (3.6 [2.1-6.2]), and hypertensive disorders (2.6 [1.1-5.8]). In early GDM, similar HbA1c associations were seen; however, lower HbA1c correlated with the greatest risk of small-for-gestational-age (P trend = 0.004) and prevalence of neonatal hypoglycemia.
Baseline HbA1c >5.9% (41 mmol/mol) identifies an increased risk of large-for-gestational-age, macrosomia, cesarean section, and hypertensive disorders in standard GDM. Although similar associations are seen in early GDM, higher HbA1c levels do not adequately capture risk-limiting utility as a triage tool in this cohort.
妊娠期糖尿病（GDM）的患病率不断上升，因此有必要进行风险分层，以便将有限的产前资源用于风险最高的人群。最近的证据表明，孕早期糖化血红蛋白（HbA1c≥5.9%（41 mmol/mol））可预测不良妊娠结局。
确定接受治疗的多民族队列中GDM患者不良妊娠结局的最佳HbA1c阈值，以及妊娠<24周与≥24周诊断的女性（早发型与标准型GDM）之间是否存在差异。
这是一项回顾性队列研究，于1991年至2011年在澳大利亚皇家阿尔弗雷德王子医院糖尿病产前诊所进行。
孕妇（N = 3098）在GDM诊断时接受了HbA1c（单一实验室）测量。前瞻性收集产妇临床和妊娠结局数据。
早发型与标准型GDM中基线HbA1c与不良妊娠结局之间的关联。
早发型GDM（n = 844）在妊娠17.6±3.3周时测量HbA1c，标准型GDM（n = 2254）在妊娠29.4±2.6周时测量。在标准型GDM中，HbA1c>5.9%（41 mmol/mol）与巨大儿（比值比[95%置信区间]=2.7[1.5 - 4.9]）、大于胎龄儿（3.5[1.4 - 8.6]）、剖宫产（3.6[2.1 - 6.2]）和高血压疾病（2.6[1.1 - 5.8]）的最大风险相关。在早发型GDM中，也观察到类似的HbA1c关联；然而，较低的HbA1c与小于胎龄儿的最大风险（P趋势=0.004）和新生儿低血糖患病率相关。
基线HbA_{1c}>5.9%（41 mmol/mol）表明标准型GDM中巨大儿、大于胎龄儿、剖宫产和高血压疾病的风险增加。虽然在早发型GDM中也观察到类似的关联，但在该队列中，较高的HbA1c水平作为一种分诊工具，不能充分体现其限制风险的作用。
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