Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
Denver Health and Hospital Authority, Denver, CO, USA.
Eur J Obstet Gynecol Reprod Biol. 2022 Nov;278:148-152. doi: 10.1016/j.ejogrb.2022.09.022. Epub 2022 Sep 26.
To determine the association between early pregnancy glycaemia, as measured by glycosylated haemoglobin A1c (HbA1c) at the first prenatal visit, and persistent postpartum diabetes mellitus (DM).
All women first diagnosed with DM during pregnancy who had both HbA1c prior to 24 weeks and postpartum DM testing were included. The proportions of women with normal (<5.7%), prediabetic (5.7-6.4%) and elevated (≥6.5%) early HbA1c who tested positive for postpartum DM were compared. Test characteristics of HbA1c to predict persistent postpartum DM were calculated.
One hundred and twenty-one women met the study inclusion criteria. HbA1c was obtained at a median gestational age of 9 weeks. Twenty-two women (18.2%) had persistent postpartum DM, which was highly correlated with early HbA1c: 16 (73%) women had an elevated HbA1c, five (22.7%) women had a prediabetic HbA1c and only one (4.5%) woman had a normal HbA1c. Of 65 women with gestational DM and a normal early HbA1c, only one (1.5%) had persistent DM within the first year (negative predictive value 98.5%). Sixteen of 18 women with an elevated early HbA1c had persistent postpartum DM (positive predictive value 88.9%). These percentages were significant overall and between groups (p < 0.001). No clinical or demographic factors were highly predictive of postpartum DM.
Early pregnancy glycaemia, as measured by HbA1c at the first prenatal visit, is highly predictive of persistent postpartum DM, and may allow clinically important risk stratification to prioritize postpartum testing and care. Postpartum DM is rare amongst women with gestational DM who begin the pregnancy with a normal HbA1c, while postpartum DM is highly likely for those with an elevated HbA1c in early pregnancy. Nearly three-quarters of women who tested positive for DM post partum had an elevated HbA1c in early pregnancy, indicating that they had undiagnosed DM prior to conception.
通过在首次产前检查时测量糖化血红蛋白（HbA1c）来确定早孕期血糖与持续性产后糖尿病（DM）之间的关系。
所有在怀孕期间首次被诊断为 DM 的女性，在 24 周前均进行 HbA1c 检查且进行产后 DM 检查，均纳入本研究。比较 HbA1c 正常（<5.7%）、糖尿病前期（5.7-6.4%）和升高（≥6.5%）的早孕期 HbA1c 女性中产后 DM 阳性的比例。计算 HbA1c 预测持续性产后 DM 的试验特征。
共有 121 名女性符合研究纳入标准。HbA1c 在中位孕龄 9 周时获得。22 名（18.2%）女性患有持续性产后 DM，与早孕期 HbA1c 高度相关：16 名（73%）女性 HbA1c 升高，5 名（22.7%）女性糖尿病前期 HbA1c，仅有 1 名（4.5%）女性 HbA1c 正常。65 名患有妊娠期 DM 和正常早孕期 HbA1c 的女性中，仅有 1 名（1.5%）在产后一年内发生持续性 DM（阴性预测值 98.5%）。18 名早孕期 HbA1c 升高的女性中，有 16 名（88.9%）患有持续性产后 DM。这些百分比在总体和组间均有显著差异（p<0.001）。没有临床或人口统计学因素能高度预测产后 DM。
通过首次产前检查时的 HbA1c 测量，早孕期血糖可高度预测持续性产后 DM，并且可能为产后检查和治疗提供重要的临床分层。对于在早孕期 HbA1c 正常的妊娠期 DM 女性，产后 DM 较为罕见，而早孕期 HbA1c 升高的女性产后 DM 极有可能。近四分之三产后 DM 阳性的女性在早孕期 HbA1c 升高，表明她们在受孕前就患有未确诊的 DM。
