Starikov Roman S, Inman Kyle, Has Phinnara, Iqbal Sara N, Coviello Elizabeth, He Mai
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA; Phoenix Perinatal Associates, Phoenix, AZ, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA.
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Placenta. 2017 Apr;52:94-99. doi: 10.1016/j.placenta.2017.02.024. Epub 2017 Mar 1.
Data on the correlation among Hemoglobin A1c (HbA1c), placental pathology, and perinatal outcome in the pregestational diabetic population is severely lacking. We believe that this knowledge will enhance the management of pregnancies complicated by pregestational diabetes. We hypothesize that placental pathology correlates with glycemic control at an early gestational age.
This is a retrospective cohort study conducted from 2003 to 2011 at a large tertiary care center. Women included had a singleton gestation, preexisting diabetes mellitus, and information about delivery and placental pathology available for review. Placental pathology and perinatal outcomes were compared across three groups of patients with differing HbA1c levels (<6.5%, 6.5-8.4%, and ≥8.5%).
293 placentas were examined. HbA1c was measured at a mean of 9.5week gestation. Median HbA1c was 7.5%, interquartile range 6.5%-8.9%. 23% of the cohort had HbA1c <6.5%, 41.9% between 6.5% and 8.4%, and 34.8% > 8.5%. BMI varied significantly by group (35.4 vs. 34.4 vs. 32.0 respectively, P = 0.04). Individual placental lesions did not vary with HbA1c levels. The incidence of acute chorioamnionitis differed significantly in the type 1 population and "distal villous hypoplasia" varied in the type 2 population.
The results show that HbA1c values in early pregnancy are poor predictors of future placental pathologies. As a result, HbA1c values obtained during early gestation (which reflect the level of glycemic control over an extended period of time) do not correlate with any particular placental pathology, despite reflecting the potential for placental insults secondary to pre-gestational diabetes.
孕前糖尿病患者中糖化血红蛋白（HbA1c）、胎盘病理学和围产期结局之间相关性的数据严重匮乏。我们认为，这方面的知识将改善对孕前糖尿病合并妊娠的管理。我们假设胎盘病理学与孕早期的血糖控制相关。
这是一项于2003年至2011年在一家大型三级医疗中心进行的回顾性队列研究。纳入的女性为单胎妊娠、患有孕前糖尿病，且有分娩和胎盘病理学信息可供查阅。对三组HbA1c水平不同（<6.5%、6.5 - 8.4%和≥8.5%）的患者的胎盘病理学和围产期结局进行了比较。
共检查了293个胎盘。HbA1c在妊娠9.5周时进行测量。HbA1c的中位数为7.5%，四分位间距为6.5% - 8.9%。该队列中23%的患者HbA1c<6.5%，41.9%在6.5%至8.4%之间，34.8%>8.5%。三组的体重指数（BMI）差异显著（分别为35.4、34.4和32.0，P = 0.04）。单个胎盘病变与HbA1c水平无关。1型人群中急性绒毛膜羊膜炎的发生率差异显著，2型人群中“远端绒毛发育不全”有所不同。
结果表明，孕早期的HbA1c值对未来胎盘病理学的预测能力较差。因此，孕早期获得的HbA1c值（反映了较长一段时间内的血糖控制水平）与任何特定的胎盘病理学均无关联，尽管它反映了孕前糖尿病继发胎盘损伤的可能性。
