Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Am J Perinatol. 2022 Oct;29(14):1496-1502. doi: 10.1055/a-1877-8696. Epub 2022 Jun 16.
This study aimed to evaluate the impact of elevated early hemoglobin A1c (HbA1c) values on perinatal outcomes in patients without a diagnosis of diabetes or gestational diabetes.
This is a retrospective study of patients with a singleton pregnancy who underwent universal HbA1c screening in early pregnancy at an urban tertiary care center between December 1, 2016, and December 31, 2018. Patients with pregestational diabetes mellitus (DM) and gestational DM (GDM) were excluded from analysis. The exposure of interest was HbA1c of 5.7 to 6.4% as measured on routine prenatal bloodwork at or during 16 weeks' gestation. The following pregnancy outcomes were assessed: preterm delivery <37 weeks, hypertensive disorders of pregnancy, shoulder dystocia, macrosomia (birth weight >4,000 g), small or large for gestational age neonate, operative vaginal delivery, third- or fourth-degree lacerations, cesarean delivery, neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, and neonatal hyperbilirubinemia. Multivariable regression was performed to assess the relationship between HbA1c and selected adverse outcomes while controlling for potential confounders RESULTS: Of the 2,621 patients who met inclusion criteria, 334 (12.7%) had an elevated HbA1c of 5.7 to 6.4%. Patients with an elevated HbA1c were more likely to be older, Black, multiparous, publically insured, obese, or have chronic hypertension than patients with normal HbA1c values. In the unadjusted analysis, patients with an elevated HbA1c were less likely to deliver at term (84.7 vs. 92.4%, = 0.006), but more likely to undergo cesarean section (32.8 vs. 27.6%, = 0.038), develop hypertensive disorders of pregnancy (31.9 vs. 23.2%, = 0.001), or deliver a macrosomic infant (10.5 vs. 6.8%, = 0.016) than those with a normal A1c. After adjusting for race, body mass index, insurance status, nulliparity, and age, however, only the relationship between HbA1c and spontaneous preterm birth remained significant (adjusted odds ratio [aOR] = 1.76, 95% confidence interval [CI]: 1.01-3.07).
In our urban population, an elevated early HbA1c was associated with spontaneous preterm birth in nondiabetic patients KEY POINTS: · In nondiabetic patients, early pregnancy HbA1c was associated with selected adverse outcomes.. · Rates of preterm birth, pregnancy-induced hypertension, cesarean section, and macrosomia were higher in patients with an elevated HbA1c.. · The relationship between early pregnancy HbA1c and spontaneous preterm birth remained significant after adjustment..
本研究旨在评估早期血红蛋白 A1c（HbA1c）升高对无糖尿病或妊娠期糖尿病诊断的患者围产期结局的影响。
这是一项回顾性研究，纳入了 2016 年 12 月 1 日至 2018 年 12 月 31 日期间在城市三级保健中心进行早期妊娠常规 HbA1c 筛查的单胎妊娠患者。排除患有孕前糖尿病（DM）和妊娠期糖尿病（GDM）的患者。本研究的暴露因素为在妊娠 16 周或 16 周内进行的常规产前血检中测量的 5.7%至 6.4%的 HbA1c。评估了以下妊娠结局：早产<37 周、妊娠高血压疾病、肩难产、巨大儿（出生体重>4000g）、胎儿小于或大于胎龄、经阴道分娩、三度或四度裂伤、剖宫产、新生儿重症监护病房（NICU）入住、新生儿低血糖和新生儿高胆红素血症。进行多变量回归分析以评估 HbA1c 与选定的不良结局之间的关系，同时控制潜在的混杂因素。
在符合纳入标准的 2621 名患者中，有 334 名（12.7%）HbA1c 升高至 5.7%至 6.4%。与 HbA1c 正常的患者相比，HbA1c 升高的患者年龄更大、为黑人、多产、有公共保险、肥胖或患有慢性高血压的可能性更高。在未调整分析中，HbA1c 升高的患者足月分娩的可能性较低（84.7% vs. 92.4%，=0.006），但剖宫产的可能性较高（32.8% vs. 27.6%，=0.038）、发生妊娠高血压疾病的可能性更大（31.9% vs. 23.2%，=0.001）或分娩巨大儿的可能性更大（10.5% vs. 6.8%，=0.016）。然而，在校正了种族、体重指数、保险状况、初产和年龄后，仅 HbA1c 与自发性早产之间的关系仍具有统计学意义（调整后的优势比[aOR] = 1.76，95%置信区间[CI]：1.01-3.07）。
在我们的城市人群中，非糖尿病患者早期妊娠 HbA1c 与某些不良结局有关。
在非糖尿病患者中，早期妊娠 HbA1c 与某些不良结局相关。HbA1c 升高的患者早产、妊娠高血压、剖宫产和巨大儿的发生率更高。早期妊娠 HbA1c 与自发性早产之间的关系在调整后仍然显著。
