Lim Yuxin, Coomarasamy Christin, Arrol Sharron, Oyston Charlotte, Okesene-Gafa Karaponi, McCowan Lesley M E
Counties Manukau Health, Auckland, New Zealand.
Middlemore Hospital, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2021 Oct;61(5):742-749. doi: 10.1111/ajo.13357. Epub 2021 May 13.
There are few data on pregnancy outcomes in women with pre-diabetes (HbA1c 41-49 mmol/mmol) at pregnancy booking. We aimed to (i) identify the proportion of women in Counties Manukau Health (CMH), South Auckland, New Zealand (NZ), with pre-diabetes at booking and (ii) compare outcomes between women with normal HbA1c and pre-diabetes.
Using data from a multi-ethnic population of 10,869 singleton pregnancies, booked at <20 weeks from January 2017 to December 2018 in CMH, we compared outcomes between those with normal HbA1c (≤40 mmol/mol) and those with pre-diabetes (HbA1c 41-49 mmol/mol). The primary outcomes were gestational diabetes mellitus (GDM) by NZ criteria and large for gestational age (LGA) defined as birthweight >90th customised centile. Logistic regression determined the contribution of HbA1c 41-49 mmol/mol to the development of GDM.
Among 10,869 participants, 193 (1.78%) had an HbA1c 41-49 mmol/mol at <20 weeks' gestation. Those with HbA1c 41-49 mmol/mol were 11 times more likely to develop GDM (59.6 vs 7.9%; adjusted odds ratio (aOR) 11.16 (7.59, 16.41)) and were more likely to have an LGA baby (47 (24.4%) vs 1436 (13.5%) aOR 1.63 (1.10, 2.41)) versus those with normal HbA1c. They also had significantly higher rates of pre-eclampsia, caesarean sections, preterm births and perinatal deaths.
Nearly two-thirds of women with a booking HbA1c of 41-49 mmol/mmol developed GDM as well as multiple other perinatal complications compared to women with HbA1c ≤40. Trials to evaluate the impact of treatment in early pregnancy on the risk of late-pregnancy complications are required.
关于妊娠早期糖尿病前期（糖化血红蛋白41 - 49 mmol/mmol）女性的妊娠结局数据较少。我们旨在（i）确定新西兰南奥克兰马努考郡健康区（CMH）妊娠早期糖尿病前期女性的比例，以及（ii）比较糖化血红蛋白正常和糖尿病前期女性的结局。
利用2017年1月至2018年12月在CMH妊娠20周前登记的10869例单胎妊娠的多民族人群数据，我们比较了糖化血红蛋白正常（≤40 mmol/mol）和糖尿病前期（糖化血红蛋白41 - 49 mmol/mol）人群的结局。主要结局是符合新西兰标准的妊娠期糖尿病（GDM）以及大于胎龄儿（LGA），定义为出生体重>第90定制百分位数。逻辑回归确定糖化血红蛋白41 - 49 mmol/mol对GDM发生的影响。
在10869名参与者中，193名（1.78%）在妊娠20周前糖化血红蛋白为41 - 49 mmol/mol。与糖化血红蛋白正常者相比，糖化血红蛋白41 - 49 mmol/mol者发生GDM的可能性高11倍（59.6%对7.9%；调整后的优势比（aOR）为11.16（7.59，16.41）），且更有可能生出大于胎龄儿（47例（24.4%）对1436例（13.5%），aOR为1.63（1.10，2.41））。她们患子痫前期、剖宫产、早产和围产期死亡的发生率也显著更高。
与糖化血红蛋白≤40的女性相比，近三分之二妊娠早期糖化血红蛋白为41 - 49 mmol/mmol的女性发生了GDM以及多种其他围产期并发症。需要进行试验来评估妊娠早期治疗对妊娠晚期并发症风险的影响。
