糖化血红蛋白升高可预测印度裔亚洲孕妇的巨大儿（WINGS - 9研究）。
Elevated glycated hemoglobin predicts macrosomia among Asian Indian pregnant women (WINGS-9).
作者信息
Bhavadharini Balaji, Mahalakshmi Manni Mohanraj, Deepa Mohan, Harish Ranjani, Malanda Belma, Kayal Arivudainambi, Belton Anne, Saravanan Ponnusamy, Ranjit Unnikrishnan, Uma Ram, Anjana Ranjit Mohan, Mohan Viswanathan
机构信息
Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
出版信息
Indian J Endocrinol Metab. 2017 Jan-Feb;21(1):184-189. doi: 10.4103/2230-8210.196003.
AIM
The aim of this study was to determine the optimal glycated hemoglobin (HbA1c) cut point for diagnosis of gestational diabetes mellitus (GDM) and to evaluate the usefulness of HbA1c as a prognostic indicator for adverse pregnancy outcomes.
METHODS
HbA1c estimations were carried out in 1459 pregnant women attending antenatal care centers in urban and rural Tamil Nadu in South India. An oral glucose tolerance test was carried out using 75 g anhydrous glucose, and GDM was diagnosed using the International Association of the Diabetes and Pregnancy Study Groups criteria.
RESULTS
GDM was diagnosed in 195 women. Receiver operating curves showed a HbA1c cut point of ≥ 5.0% (≥31 mmol/mol) have a sensitivity of 66.2% and specificity of 56.2% for identifying GDM (area under the curve 0.679, confidence interval [CI]: 0.655-0.703). Women with HbA1c ≥ 5.0% (≥31 mmol/mol) were significantly older and had higher body mass index, greater history of previous GDM, and a higher prevalence of macrosomia compared to women with HbA1c < 5.0% (<31 mmol/mol). The adjusted odds ratio for macrosomia in those with HbA1c ≥ 5.0% (≥31 mmol/mol) was 1.92 (CI: 1.24-2.97, = 0.003). However, other pregnancy outcomes were not significantly different.
CONCLUSION
In Asian Indian pregnant women, a HbA1c of 5.0% (31 mmol/mol) or greater is associated with increased risk of macrosomia.
目的
本研究旨在确定用于诊断妊娠期糖尿病（GDM）的最佳糖化血红蛋白（HbA1c）切点，并评估HbA1c作为不良妊娠结局预后指标的有效性。
方法
对印度南部泰米尔纳德邦城乡产前护理中心的1459名孕妇进行HbA1c测定。采用75克无水葡萄糖进行口服葡萄糖耐量试验，并根据国际糖尿病与妊娠研究组协会标准诊断GDM。
结果
195名妇女被诊断为GDM。受试者工作曲线显示，HbA1c切点≥5.0%（≥31 mmol/mol）识别GDM的灵敏度为66.2%，特异度为56.2%（曲线下面积0.679，置信区间[CI]：0.655 - 0.703）。与HbA1c < 5.0%（<31 mmol/mol）的妇女相比，HbA1c≥5.0%（≥31 mmol/mol）的妇女年龄显著更大，体重指数更高，既往GDM病史更多，巨大儿患病率更高。HbA1c≥5.0%（≥31 mmol/mol）者发生巨大儿的校正比值比为1.92（CI：1.24 - 2.97，P = 0.003）。然而，其他妊娠结局无显著差异。
结论
在亚洲印度裔孕妇中，HbA1c≥5.0%（31 mmol/mol）与巨大儿风险增加相关。
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