Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Adv Ther. 2023 Mar;40(3):951-960. doi: 10.1007/s12325-022-02405-w. Epub 2022 Dec 22.
To evaluate the differences in the continuous glucose monitoring system (CGMS) profiles of women in early pregnancy stratified based on different HbA1c levels known to be predictive of gestational diabetes mellitus (GDM) at 24-28 weeks of gestation (≥ 5.2%) and adverse pregnancy outcomes (≥ 5.5%) in Indian women.
We enrolled women at 8 to 19 weeks of gestation (early pregnancy), evaluated the glycaemic parameters of clinical interest using CGMS, and reported them per standard methodology proposed by Hernandez et al. WHO 2013 criteria were used for diagnosis of early GDM.
Ninety-six women were enrolled at 14.0 ± 3.2 weeks of gestation. Of these, 38 were found to have early GDM (diagnosed before 20 weeks of gestation) on evaluation. Of 96 women, 33 (34.4%) had HbA1c value ≥ 5.5% [11 (19.0%) with normoglycaemia and 22 (57.9%) with GDM]. The women with elevated HbA1c differed significantly from those with HbA1c < 5.5% for all evaluated parameters. The differences for overall women were > 10 mg/dl (0.56 mmol/l) for 1-h postprandial glucose (difference of 0.78 mmol/l), 2-h postprandial glucose (difference of 0.59 mmol/l), peak postprandial glucose (difference of 0.75 mmol/l), and 1-h postprandial glucose excursion (difference of 0.59 mmol/l). Of 58 women with normoglycaemia, 29 (50.0%) had an HbA1c value ≥ 5.2%. In comparison, in the normoglycaemic group of women with and without HbA1c ≥ 5.2% (known to be predictive of future GDM), the results were significant for 1-h (difference of 0.44 mmol/l), 2-h (difference of 0.278 mmol/l), and peak postprandial glucose (difference of 0.35 mmol/l).
The results suggest that women with elevated HbA1c (≥ 5.5%) in early pregnancy significantly differ from those with HbA1c < 5.5% in all glycaemic parameters evaluated in this study, suggesting that HbA1c at this cut-off has a role to play in early pregnancy.
评估根据不同的糖化血红蛋白（HbA1c）水平分层的早孕期妇女的连续血糖监测系统（CGMS）谱的差异，这些水平已知可预测印度妇女在 24-28 周妊娠时发生妊娠期糖尿病（GDM）（≥5.2%）和不良妊娠结局（≥5.5%）。
我们在 8 至 19 周妊娠（早孕期）期间招募了妇女，使用 CGMS 评估了临床相关的血糖参数，并按照 Hernandez 等人提出的标准方法报告了这些参数。使用世界卫生组织 2013 年标准来诊断早期 GDM。
在 14.0±3.2 周的妊娠时，有 96 名妇女入组。其中，38 名妇女在评估时被诊断为早发性 GDM（在 20 周前诊断）。在 96 名妇女中，有 33 名（34.4%）HbA1c 值≥5.5%[11 名（19.0%）血糖正常，22 名（57.9%）患有 GDM]。HbA1c 升高的妇女与 HbA1c<5.5%的妇女在所有评估参数上均有显著差异。对于所有女性，1 小时餐后血糖（差异 0.78mmol/L）、2 小时餐后血糖（差异 0.59mmol/L）、餐后血糖峰值（差异 0.75mmol/L）和 1 小时餐后血糖波动（差异 0.59mmol/L）的差异均超过 10mg/dL（0.56mmol/L）。在 58 名血糖正常的妇女中，有 29 名（50.0%）HbA1c 值≥5.2%。相比之下，在 HbA1c 值≥5.2%（已知可预测未来 GDM）的血糖正常妇女的正常组和非正常组中，1 小时（差异 0.44mmol/L）、2 小时（差异 0.278mmol/L）和餐后血糖峰值（差异 0.35mmol/L）的结果均有显著差异。
结果表明，HbA1c 升高（≥5.5%）的早孕期妇女与 HbA1c<5.5%的妇女在本研究评估的所有血糖参数方面存在显著差异，这表明该切点的 HbA1c 在早孕期具有一定的作用。
