Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.
Diabet Med. 2022 Jul;39(7):e14822. doi: 10.1111/dme.14822. Epub 2022 Mar 8.
To determine whether a net decline in glycosylated haemoglobin (HbA ) from early to late pregnancy is associated with lower risk of adverse perinatal outcomes at delivery among women with pregestational diabetes.
A retrospective analysis from 2012 to 2016 at a tertiary care centre. The exposure was the net change in HbA from early (<20 weeks gestation) to late pregnancy (≥20 weeks gestation). Primary outcomes were large for gestational age (LGA) and neonatal hypoglycaemia. The association between outcomes per 6 mmol/mol (0.5%) absolute decrease in HbA was evaluated using modified Poisson regression, and adjusted for age, body mass index, White Class, early HbA and haemoglobin and gestational age at HbA measurement and delivery.
Among 347 women with pregestational diabetes, HbA was assessed in early (9 weeks [IQR 7,13]) and late pregnancy (31 weeks [IQR 29,34]). Mean HbA decreased from early (59 mmol/mol [7.5%]) to late (47 mmol/mol [6.5%]) pregnancy. Each 6 mmol/mol (0.5%) absolute decrease in HbA was associated with a 12% reduced risk of LGA infant (30%, aRR:0.88; 95% CI:0.81,0.95), and a 7% reduced risk of neonatal hypoglycaemia (35%, aRR:0.93; 95% CI:0.87,0.99). Preterm birth (36%, aRR:0.93; 95% CI:0.89,0.98) and neonatal intensive care unit admission (55%, aRR:0.95; 95% CI:0.91,0.98) decreased with a net decline in HbA , but not caesarean delivery, pre-eclampsia, shoulder dystocia and respiratory distress syndrome.
Women with pregestational diabetes with a reduction in HbA may have fewer infants born LGA or with neonatal hypoglycaemia. Repeated assessment of HbA may provide an additional measure of glycaemic control.
确定孕前糖尿病女性在早孕期到晚孕期期间糖化血红蛋白（HbA ）净下降是否与分娩时不良围产结局风险降低有关。
这是 2012 年至 2016 年在一家三级保健中心进行的回顾性分析。暴露因素是早孕期（<20 孕周）到晚孕期（≥20 孕周）HbA 的净变化。主要结局是巨大儿（LGA）和新生儿低血糖症。使用校正泊松回归评估每降低 6mmol/mol（0.5%）HbA 绝对变化与结局的关系，并校正年龄、体重指数、White 分级、早孕期 HbA 和血红蛋白、HbA 测量和分娩时的孕周。
在 347 例孕前糖尿病女性中，HbA 在早孕期（9 周[IQR 7,13]）和晚孕期（31 周[IQR 29,34]）进行了评估。HbA 从早孕期（59mmol/mol[7.5%]）降至晚孕期（47mmol/mol[6.5%]）。HbA 每降低 6mmol/mol（0.5%）绝对变化与 LGA 婴儿风险降低 12%相关（30%，aRR：0.88；95%CI：0.81，0.95），新生儿低血糖症风险降低 7%相关（35%，aRR：0.93；95%CI：0.87，0.99）。早产（36%，aRR：0.93；95%CI：0.89，0.98）和新生儿重症监护病房入院（55%，aRR：0.95；95%CI：0.91，0.98）随 HbA 的净下降而减少，但剖宫产、子痫前期、肩难产和呼吸窘迫综合征则不然。
HbA 下降的孕前糖尿病女性其 LGA 婴儿或新生儿低血糖症的发生可能减少。HbA 的重复评估可能提供血糖控制的额外衡量标准。
