Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the College of Medicine, the Division of Endocrinology, Department of Medicine, and the Department of Bioinformatics, The Ohio State University, Columbus, Ohio.
Obstet Gynecol. 2022 Jun 1;139(6):1051-1060. doi: 10.1097/AOG.0000000000004727. Epub 2022 May 2.
To evaluate the association between community-level social vulnerability and achieving glycemic control (defined as hemoglobin A1c [Hb A1c] less than 6.0% or less than 6.5%) among individuals with pregestational diabetes.
We conducted a retrospective cohort of individuals with pregestational diabetes with singleton gestations from 2012 to 2016 at a tertiary care center. Addresses were geocoded using ArcGIS and then linked at the census tract to the Centers for Disease Control and Prevention's 2018 SVI (Social Vulnerability Index), which incorporates 15 Census variables to produce a composite score and four scores across thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). Scores range from 0 to 1, with higher values indicating greater community-level social vulnerability. The primary outcome was Hb A1c less than 6.0%, and, secondarily, Hb A1c less than 6.5%, in the second or third trimesters. Multivariable Poisson regression with robust error variance was used to evaluate the association between SVI score as a continuous measure and target Hb A1c.
Among 418 assessed pregnant individuals (33.0% type 1; 67.0% type 2 diabetes), 41.4% (173/418) achieved Hb A1c less than 6.0%, and 56.7% (237/418) Hb A1c less than 6.5% at a mean gestational age of 29.5 weeks (SD 5.78). Pregnant individuals with a higher SVI score were less likely to achieve Hb A1c less than 6.0% compared with those with a lower SVI score. For each 0.1-unit increase in SVI score, the risk of achieving Hb A1c less than 6.0% decreased by nearly 50% (adjusted risk ratio [aRR] 0.53; 95% CI 0.36-0.77), and by more than 30% for Hb A1c less than 6.5% (adjusted odds ratio 0.67; 95% CI 0.51-0.88). With regard to specific SVI domains, those who scored higher on socioeconomic status (aRR 0.50; 95% CI 0.35-0.71) as well as on household composition and disability (aRR 0.55; 95% CI 0.38-0.79) were less likely to achieve Hb A1c less than 6.0%.
Pregnant individuals with pregestational diabetes living in an area with higher social vulnerability were less likely to achieve glycemic control, as measured by HgbA1c levels. Interventions are needed to assess whether addressing social determinants of health can improve glycemic control in pregnancy.
评估社区层面社会脆弱性与孕前糖尿病患者血糖控制达标（定义为血红蛋白 A1c [Hb A1c]＜6.0%或＜6.5%）之间的关系。
我们对 2012 年至 2016 年在一家三级医疗中心接受单胎妊娠的孕前糖尿病患者进行了回顾性队列研究。使用 ArcGIS 对地址进行地理编码，然后将地址链接到疾病控制与预防中心（Centers for Disease Control and Prevention）的 2018 年 SVI（社会脆弱性指数），该指数包含 15 个人口普查变量，以产生一个综合得分和四个主题领域（社会经济地位、家庭构成和残疾、少数族裔地位和语言以及住房类型和交通）的得分。分数范围从 0 到 1，数值越高表示社区层面的社会脆弱性越高。主要结局是在妊娠第 2 或第 3 个三个月时 Hb A1c＜6.0%，其次是 Hb A1c＜6.5%。采用稳健方差的多变量泊松回归来评估 SVI 评分作为连续测量值与目标 Hb A1c 之间的关联。
在 418 名评估的孕妇中（1 型糖尿病 33.0%；2 型糖尿病 67.0%），41.4%（173/418）在平均孕龄为 29.5 周（SD 5.78）时达到 Hb A1c＜6.0%，56.7%（237/418）达到 Hb A1c＜6.5%。与 SVI 评分较低的孕妇相比，SVI 评分较高的孕妇达到 Hb A1c＜6.0%的可能性较低。SVI 评分每增加 0.1 个单位，达到 Hb A1c＜6.0%的风险就会降低近 50%（调整风险比[aRR]0.53；95%CI 0.36-0.77），达到 Hb A1c＜6.5%的风险也会降低 30%以上（调整比值比[aOR]0.67；95%CI 0.51-0.88）。关于特定的 SVI 领域，那些在社会经济地位方面得分较高（aRR 0.50；95%CI 0.35-0.71）以及在家庭构成和残疾方面得分较高的孕妇（aRR 0.55；95%CI 0.38-0.79）达到 Hb A1c＜6.0%的可能性较低。
在社会脆弱性较高的地区，患有孕前糖尿病的孕妇达到血糖控制目标的可能性较低，这是通过 HgbA1c 水平来衡量的。需要评估是否可以通过解决健康的社会决定因素来改善妊娠期间的血糖控制。
