妊娠前糖尿病与妊娠：孕早期糖化血红蛋白可识别澳大利亚原住民妇女中妊娠期糖尿病和不良围产结局的高危人群。

Prediabetes and pregnancy: Early pregnancy HbA identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes.

机构信息

The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia.

The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia.

出版信息

Diabetes Res Clin Pract. 2021 Jun;176:108868. doi: 10.1016/j.diabres.2021.108868. Epub 2021 May 21.

DOI:10.1016/j.diabres.2021.108868

PMID:34023341

Abstract

AIMS

To assess whether early pregnancy HbA can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women.

METHODS

Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn.

RESULTS

Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8-88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03-4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy.

CONCLUSIONS

Early pregnancy HbA ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.

摘要

目的

评估澳大利亚女性孕早期血红蛋白 A（HbA）能否预测妊娠糖尿病（GDM）和不良分娩结局。

方法

这是一项对 466 名无糖尿病的女性进行的前瞻性研究，这些女性在首次产前就诊时年龄≥16 岁。研究招募于 2015 年 1 月 9 日至 2018 年 5 月 31 日在澳大利亚农村和偏远地区的 27 个初级保健站点进行。HbA 是在第一次产前检查时（妊娠<20 周）测量的。主要观察指标是 HbA 通过常规 75g 口服葡萄糖耐量试验（OGTT；妊娠≥24 周）预测 GDM，以及预测巨大儿（LGA）新生儿的价值。

结果

在 396 名（129 名土著人）进行常规 OGTT 的女性中，28.8%患有 GDM（24.0%为土著人）。HbA≥5.6%（≥38mmol/mol）对土著女性的 GDM 具有高度预测性（71.4%，95%CI；47.8-88.7%），并且在整个队列中增加了 LGA 新生儿的风险（RR 2.04，95%CI；1.03-4.01，P=0.040）。土著女性和非土著女性之间存在明显差异：HbA 升高的比例分别为 16.3%和 5.2%（P<0.001），而怀孕期间发生高血糖的比例分别为 12.4%和 29.6%（P<0.001）。