Sioux Lookout NOSM Local Education Group, Sioux Lookout, ON.
Northern Ontario School of Medicine, Sioux Lookout, ON.
J Obstet Gynaecol Can. 2020 Nov;42(11):1379-1384. doi: 10.1016/j.jogc.2019.12.015. Epub 2020 Apr 6.
This review sought to examine the association of HbA levels <6.5% in early pregnancy with the subsequent development of gestational diabetes mellitus (GDM) and adverse pregnancy outcomes.
A search of Medline and EMBASE was conducted for the period of January 1, 2000 to July 9, 2019 and the terms: "gestational diabetes or pregnancy diabetes mellitus" and "glycosylated hemoglobin or glycated hemoglobin A" and "pregnancy trimester, first, or first-trimester pregnancy," "screening or prenatal screening," "prenatal diagnosis or early diagnosis or prediction," "retrospective studies or prospective studies." Quality of evidence was assessed using the Newcastle-Ottawa scale. Inclusion criteria were: measurement of HbA <20 weeks gestation, the absence of pre-gestational diabetes mellitus, and analysis of HbA levels below 6.5%. The primary outcome evaluated was the development of GDM. Secondary outcomes were adverse pregnancy outcomes, including large-for-gestational-age birth weight, macrosomia, preterm birth, neonatal and perinatal death, congenital anomaly, preeclampsia, shoulder dystocia, and cesarean section.
We screened 121 relevant abstracts. Thirty-two studies qualified for a full review, of which 11 met the eligibility criteria. All studies were assessed as high quality and found an increased risk of GDM with HbA levels >5.7. Levels >6.0 identified all patients who developed GDM. Adverse pregnancy outcomes were associated with elevated HbA levels in 4 of 6 studies and included preeclampsia, induced labour, shoulder dystocia, cesarean section, large-for-gestational-age birth weight, macrosomia, congenital anomalies, and perinatal death. Two studies found no association with adverse events.
HbA levels between 5.7% and 6.4% in early pregnancy consistently identified patients who went on to develop GMD. The evidence that particular levels are associated with adverse outcomes is less robust.
本综述旨在探讨孕早期 HbA<6.5%与随后发生妊娠糖尿病（GDM）和不良妊娠结局的关系。
检索 Medline 和 EMBASE 数据库，检索时间为 2000 年 1 月 1 日至 2019 年 7 月 9 日，检索词包括：“妊娠糖尿病或妊娠糖尿病”和“糖化血红蛋白或糖化血红蛋白 A”和“妊娠早期或第一孕期”和“筛查或产前筛查”和“产前诊断或早期诊断或预测”和“回顾性研究或前瞻性研究”。使用纽卡斯尔-渥太华量表评估证据质量。纳入标准为：在妊娠 20 周前测量 HbA，无孕前糖尿病，分析 HbA 水平低于 6.5%。主要结局为 GDM 的发生。次要结局为不良妊娠结局，包括巨大儿出生体重、巨大儿、早产、新生儿和围产儿死亡、先天畸形、子痫前期、肩难产和剖宫产。
我们筛选了 121 篇相关摘要。32 项研究符合全文审查标准，其中 11 项符合纳入标准。所有研究均被评估为高质量，且发现 HbA 水平>5.7 与 GDM 风险增加相关。HbA 水平>6.0 可识别出所有发生 GDM 的患者。在 6 项研究中的 4 项中，HbA 水平升高与不良妊娠结局相关，包括子痫前期、引产、肩难产、剖宫产、巨大儿出生体重、巨大儿、先天畸形和围产儿死亡。两项研究发现与不良事件无关联。
孕早期 HbA 水平在 5.7%至 6.4%之间可确定患者是否会发展为 GMD。特定水平与不良结局相关的证据不太可靠。
