Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China.
Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China.
Acta Diabetol. 2024 Oct;61(10):1225-1230. doi: 10.1007/s00592-024-02283-4. Epub 2024 May 11.
Previous studies have shown that higher hemoglobin A1c (HbA1c) levels within the normal range during pregnancy can increase the risk of adverse birth outcomes. However, the effects of the longitudinal HbA1c trajectory during pregnancy on adverse birth outcomes among non-gestational diabetic women are poorly characterized. We aimed to identify HbA1c trajectory during pregnancy among non-gestational diabetic women and to estimate their associations with adverse birth outcomes.
Data was extracted from the Information System of Guangdong Women and Children Hospital, China, from January 2017 to July 2022. This study involved 13,979 women who did not have gestational diabetes mellitus and underwent repeated HbA1c measurements during pregnancy. Latent mixture modeling was used to identify HbA1c trajectory groups. Logistic regression was applied to explore the associations between HbA1c trajectory groups and adverse birth outcomes, including preterm delivery, low birth weight, macrosomia, small for gestational age, and large for gestational age (LGA).
Three HbA1c trajectory groups were identified: low-stable (range 4.0% [20 mmol/mol]-4.4% [25 mmol/mol]), moderate-stable (range 4.6% [27 mmol/mol]-5.1% [32 mmol/mol]), and elevated-increasing (range 5.0% [31 mmol/mol]-5.6% [38 mmol/mol]). Compared with the low-stable HbA1c group, the elevated-increasing group had a higher risk of preterm delivery and LGA. The adjusted OR (95% CIs) were 1.67 (1.13, 2.49) and 1.47 (1.01, 2.12) for preterm delivery and LGA, respectively.
Among non-gestational diabetic women, the elevated-increasing HbA1c trajectory group was associated with a higher risk of preterm delivery and LGA. This finding emphasizes the importance of maintaining optimal HbA1c levels throughout pregnancy.
既往研究表明，孕期正常范围内较高的糖化血红蛋白（HbA1c）水平会增加不良妊娠结局的风险。然而，非妊娠糖尿病女性孕期 HbA1c 纵向轨迹对不良妊娠结局的影响尚不清楚。本研究旨在确定非妊娠糖尿病女性孕期的 HbA1c 轨迹，并评估其与不良妊娠结局的关系。
数据来自中国广东省妇女儿童医院信息系统，时间为 2017 年 1 月至 2022 年 7 月，共纳入 13979 例未患妊娠期糖尿病且孕期多次检测 HbA1c 的女性。采用潜在混合模型识别 HbA1c 轨迹组。采用 logistic 回归探讨 HbA1c 轨迹组与不良妊娠结局（早产、低出生体重、巨大儿、小于胎龄儿和大于胎龄儿）的关系。
共识别出 3 种 HbA1c 轨迹组：低稳定组（范围 4.0%[20mmol/mol]-4.4%[25mmol/mol]）、中稳定组（范围 4.6%[27mmol/mol]-5.1%[32mmol/mol]）和升高递增组（范围 5.0%[31mmol/mol]-5.6%[38mmol/mol]）。与低稳定 HbA1c 组相比，升高递增组早产和大于胎龄儿的风险更高。调整后的 OR（95%CI）分别为 1.67（1.13，2.49）和 1.47（1.01，2.12）。
在非妊娠糖尿病女性中，升高递增 HbA1c 轨迹组与早产和大于胎龄儿的风险增加相关。这一发现强调了在整个孕期维持最佳 HbA1c 水平的重要性。
