Western Sydney University, Sydney, New South Wales, Australia.
Counties Manukau District Health Board, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2021 Feb;61(1):69-77. doi: 10.1111/ajo.13231. Epub 2020 Sep 2.
Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery.
To compare pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders.
A retrospective and prospective single-centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening.
HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03).
Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation.
妊娠结局不良在血糖升高的女性中更为常见。许多女性在产后接受糖化血红蛋白检测的比例不理想。
比较不同孕期血糖升高程度的多民族女性的妊娠结局，并比较产后糖化血红蛋白检测的情况，同时分析其与产后接受电子邮件提醒之间的关系。
本研究是在奥克兰南部的一家单中心进行的回顾性和前瞻性研究，纳入了 2639 名患有早期妊娠糖尿病（GDM）（<20 周诊断）、晚期 GDM（≥20 周诊断）、显性妊娠糖尿病或已知有妊娠 2 型糖尿病（T2DM）的女性。采用自动化电子邮件提醒的方式，提醒全科医生增加产后糖化血红蛋白筛查。
在晚期 GDM（n=1425）、早期 GDM（n=148）、显性糖尿病（n=573）和 T2DM（n=493）组中，糖化血红蛋白在孕期逐渐升高（P<0.001）。在晚期 GDM 组中，死胎的发生率最低（分别为 0、0.7、0.5 和 1.9%，P<0.001），剖宫产率（分别为 32.7、45.1、39.4 和 53.5%，P<0.001）、巨大儿（分别为 14.7、18.2、22.3 和 30.5%，P<0.001）、小于胎龄儿（分别为 8.8、16.7、11.0 和 11.1%，P=0.02）和子痫前期/子痫（分别为 7.7、9.2、13.0 和 14.8%，P<0.001）的发生率也较低。与欧洲女性相比，太平洋岛民和毛利女性的巨大儿和子痫前期/子痫更为常见（巨大儿，分别为 30.1、22.7、10.3%，P<0.001；子痫前期/子痫，分别为 13.5、14.0 和 8.1%，P<0.001）。在引入提醒电子邮件后，GDM/显性糖尿病女性的产后糖化血红蛋白筛查率有所增加（分别为 39.6%和 34.0%，P=0.03）。
晚期 GDM 女性的不良结局风险最低。通过电子邮件提醒来提高产后糖化血红蛋白检测率的方法值得进一步研究。
