Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
Department of Obstetrics & Gynecology, Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
Diabetes Res Clin Pract. 2018 Sep;143:50-55. doi: 10.1016/j.diabres.2018.06.021. Epub 2018 Jun 30.
Aim To evaluate antenatal HbA1c at diagnosis and in the 4 weeks preceding delivery to predict early postpartum diabetes mellitus (DM) in women with Gestational Diabetes Mellitus (GDM). Methods Seventy-eight women with GDM were prospectively assessed. The ability of HbA1c at GDM diagnosis (t1) and in the 4 weeks preceding delivery (t2) to predict DM 6-12 weeks after delivery was investigated. Glucose assessment was performed between November 1, 2015, and November 1, 2016 at Tygerberg Hospital (TH), Cape Town, South Africa (SA). Individuals with known pre-existing diabetes were excluded. Results HbA1c of 6.2% (44 mmol/mol) and 6.5% (48 mmol/mol) at t1 predicted DM with sensitivities of 95% and 90% and specificities of 62% and 70% respectively. At t2 the best cut-off for HbA1c, in accordance with t1, was also 6.2% (44 mmol/mol; sensitivity 92%, specificity 56%). Nineteen of the 29 women with suspected pre-gestational DM had HbA1c levels ≥ 6.5% (48 mmol/mol) at t1. The increased risk for postpartum DM with HbA1c ≥ 6.2% (44 mmol/mol) was four-fold (OR 3.97 CI 2.08-7.59p < 0.001) at t1 and five-fold (OR 5.08 CI 1.60-16.25 p = 0.006) at t2. Conclusion HbA1c lower than 6.5% (48 mmol/mol) predicts postpartum DM in women with GDM. HbA1c can serve as instrument to improve postpartum follow-up.
目的 评估妊娠期糖尿病（GDM）患者诊断时及分娩前 4 周的糖化血红蛋白（HbA1c）水平，以预测其产后早期糖尿病（DM）。
方法 前瞻性评估了 78 例 GDM 患者。研究了 GDM 诊断时（t1）和分娩前 4 周（t2）的 HbA1c 预测产后 6-12 周 DM 的能力。葡萄糖评估于 2015 年 11 月 1 日至 2016 年 11 月 1 日在南非开普敦泰格伯格医院（TH）进行。排除已知患有糖尿病前期的个体。
结果 t1 时 HbA1c 为 6.2%（44mmol/mol）和 6.5%（48mmol/mol）预测 DM 的敏感性分别为 95%和 90%，特异性分别为 62%和 70%。t2 时，与 t1 时一致，HbA1c 的最佳截断值也为 6.2%（44mmol/mol；敏感性 92%，特异性 56%）。29 例疑似孕前糖尿病的女性中，19 例 t1 时的 HbA1c 水平≥6.5%（48mmol/mol）。t1 时 HbA1c≥6.2%（44mmol/mol）与产后 DM 风险增加 4 倍（OR 3.97，95%CI 2.08-7.59，p<0.001），t2 时风险增加 5 倍（OR 5.08，95%CI 1.60-16.25，p=0.006）。
结论 GDM 患者 HbA1c 低于 6.5%（48mmol/mol）可预测产后 DM。HbA1c 可作为改善产后随访的工具。
