Department of Public Health, San Diego State University, Joint Doctoral Program in Public Health, San Diego, California, USA.
Department of Pediatrics, University of California, San Diego, La Jolla, California, USA.
J Womens Health (Larchmt). 2023 Mar;32(3):274-282. doi: 10.1089/jwh.2022.0256. Epub 2023 Feb 16.
Preconception diabetes is strongly associated with adverse birth outcomes. Less is known about the effects of elevated glycemia at levels below clinical cutoffs for diabetes. In this study, we estimated associations between preconception diabetes, prediabetes, and hemoglobin A1c (HbA1c) on the risk of preterm birth, and evaluated whether associations were modified by access to or utilization of health care services. We used data from Add Health, a US prospective cohort study with five study waves to date. At Wave IV (ages 24-32), glucose and HbA1c were measured. At Wave V (ages 32-42), women with a live birth reported whether the baby was born preterm. The analytic sample size was 1989. The prevalence of preterm birth was 13%. Before pregnancy, 6.9% of women had diabetes, 23.7% had prediabetes, and 69.4% were normoglycemic. Compared to the normoglycemic group, women with diabetes had 2.1 (confidence interval [95% CI]: 1.5-2.9) times the risk of preterm birth, while women with prediabetes had 1.3 (95% CI: 1.0, 1.7) times the risk of preterm birth. There was a nonlinear relationship between HbA1c and preterm birth such that risk of preterm birth emerged after HbA1c = 5.7%, a standard cutoff for prediabetes. The excess risks of preterm birth associated with elevated HbA1c were four to five times larger among women who reported unstable health care coverage and among women who used the emergency room as usual source of care. Our findings replicate prior research showing strong associations between preconception diabetes and preterm birth, adding that prediabetes is also associated with higher risk. Policies and interventions to enhance access and utilization of health care among women before pregnancy should be examined.
孕前糖尿病与不良出生结局密切相关。对于血糖水平高于糖尿病临床切点但低于切点时的影响知之甚少。本研究旨在估计孕前糖尿病、糖尿病前期和糖化血红蛋白（HbA1c）与早产风险的关系，并评估这些关系是否受获得或利用医疗保健服务的影响。本研究使用了美国前瞻性队列研究 Add Health 的数据，该研究迄今为止已进行了五轮调查。在第四轮调查（年龄 24-32 岁）中，测量了血糖和 HbA1c。在第五轮调查（年龄 32-42 岁）中，有活产婴儿的女性报告了婴儿是否早产。分析样本量为 1989 名。早产的患病率为 13%。在怀孕前，6.9%的女性患有糖尿病，23.7%的女性患有糖尿病前期，69.4%的女性血糖正常。与血糖正常组相比，糖尿病女性早产的风险增加了 2.1 倍（95%可信区间：1.5-2.9），而糖尿病前期女性早产的风险增加了 1.3 倍（95%可信区间：1.0-1.7）。HbA1c 与早产之间存在非线性关系，即 HbA1c 水平达到 5.7%后，即糖尿病前期的标准切点，早产风险开始出现。在报告医疗保健覆盖不稳定和经常使用急诊室作为常规医疗来源的女性中，与升高的 HbA1c 相关的早产额外风险是 4 到 5 倍。本研究结果与之前的研究一致，即孕前糖尿病与早产密切相关，此外，糖尿病前期也与更高的风险相关。应研究在怀孕前增强女性获得和利用医疗保健的政策和干预措施。
