Nielsen G L, Sørensen H T, Nielsen P H, Sabroe S, Olsen J
Department of Obstetrics, Aalborg Hospital, Denmark.
Acta Diabetol. 1997 Oct;34(3):217-22. doi: 10.1007/s005920050077.
The study aimed to determine whether a consistent dose-response association can be demonstrated, after adjustment for maternal age and White classification, between glycosylated hemoglobin (HbA1c) values before conception and in the first trimester of pregnancy of insulin-dependent diabetic mothers and adverse fetal outcome (abortions and major malformations). This is a historical follow-up study based on medical records in a geographically defined catchment area. The study comprised 60 pregnancies with HbA1c determinations before pregnancy and 161 with HbA1c in the first trimester in women with type 1 diabetes admitted between 1980 and 1992. Relative risk calculations indicated a highly significant and consistent correlation between HbA1c values above 6.6% and adverse fetal outcome after adjustment for differences in maternal age and White classification. Our data support a clinically significant and consistent relationship between adverse fetal outcome and HbA1c in the first trimester of pregnancy of type 1 mothers, without any indication of a cut-off level below which further improvement in HbA1c was of minor importance.
该研究旨在确定，在对母亲年龄和怀特分类进行校正之后，胰岛素依赖型糖尿病母亲在受孕前及妊娠早期的糖化血红蛋白（HbA1c）值与不良胎儿结局（流产和严重畸形）之间是否能显示出一致的剂量反应关联。这是一项基于特定地理区域内医疗记录的历史性随访研究。该研究纳入了60例在怀孕前测定了HbA1c的妊娠病例，以及161例在1980年至1992年间入院的1型糖尿病女性在妊娠早期测定了HbA1c的病例。相对风险计算表明，在对母亲年龄和怀特分类的差异进行校正后，HbA1c值高于6.6%与不良胎儿结局之间存在高度显著且一致的相关性。我们的数据支持1型母亲妊娠早期不良胎儿结局与HbA1c之间存在具有临床意义的一致关系，且没有任何迹象表明存在一个临界值，低于该值后HbA1c的进一步改善就变得不太重要。
