"High prepregnancy HbA1c is challenging to improve and affects insulin requirements, gestational length, and birthweight". Issue 11 (18th June 2020)

• Record Type: Journal Article
• Authors: Skajaa, Gitte Oeskov; Kampmann, Ulla; Fuglsang, Jens; Ovesen, Per Glud
• Is Part Of: Journal of diabetes. Volume 12:Issue 11(2020)
• Page Start: 798
• Page End: 806
• Publication Date: 2020-06-18
• Subjects: birthweight -- gestational length -- glycemic control -- HbA1c -- high‐risk pregnancy -- insulin sensitivity -- type 1 diabetes mellitus; 出生体重 -- 孕长 -- 血糖控制 -- 糖化血红蛋白 -- 高危妊娠 -- 胰岛素敏感性 -- 1型糖尿病; Diabetes -- Periodicals; 618.3646005
• DOI: 10.1111/1753-0407.13070
• Languages: English
• ISSNs: 1753-0393

Abstract

Abstract: Background: The aim of this study was to explore how prepregnancy glycosylated hemoglobin (HbA1c) affects the course of HbA1c and insulin requirements during pregnancy, the gestational length, and birthweight. Methods: An observational cohort study was conducted consisting of 380 women with type 1 diabetes who gave birth 530 times from 2004 to 2014. The participants were divided into four groups according to prepregnancy HbA1c. Results: HbA1c was significantly different between the groups at all time intervals from week 5 to 10 to week 33 to 36 ( P ≤ .01). In group 1, with the lowest prepregnancy HbA1c (<6.5% [48 mmol/mol]), HbA1c stayed at the same level throughout pregnancy. In the other groups (group 2: 6.5% [48 mmol/mol]‐7.9% [63 mmol/mol], group 3: 8% [64 mmol/mol]‐9.9% [86 mmol/mol], and group 4: > 10% [86 mmol/mol]) a decrease in HbA1c was seen in early pregnancy but stabilized from midpregnancy onward. Group 1 had the lowest daily insulin requirements throughout pregnancy among the four groups ( P = .001). The relationship between birthweight and prepregnancy HbA1c was found to be inversely U‐shaped. Mean gestational length in group 4 was significantly shorter than in group 1 ( P = .001). Conclusions: In this very large cohort, we found that a poor prepregnancy HbA1c is a predictor for poor glycemic control during pregnancy and that HbA1c decreases until midpregnancy and then plateaus. A very poor prepregnancy HbA1c is associated with shorter gestational length and lower birthweight, which is contrary to the common assumption that poor glycemic control leads to higher birthweight. Abstract : Highlights In this very large cohort of 530 pregnancies in women with type 1 diabetes mellitus, we found that high prepregnancy glycosylated hemoglobin (HbA1c) is a predictor for suboptimal glycemic control during pregnancy and that HbA1c only decreases until midpregnancy and then plateaus. In addition, a very high prepregnancy HbA1c is associated with shorter gestational length and lower birthweight z score, which is contrary to the common assumption of poor glycemic control leading to higher birthweight. 摘要: 背景: 本研究旨在探讨孕前糖化血红蛋白(HbA1c)对孕期HbA1c进程和胰岛素需求、孕周和出生体重的影响。 方法: 对2004年至2014年间总计生育530次的380例1型糖尿病妇女进行观察性队列研究。受试者根据孕前HbA1c水平分为四组。 结果: HbA1c在5~10周、33~36周各时间点组间差异均有统计学意义( P <0.01); 第1组孕前HbA1c最低(<6.5%[48 mmol/mol]), 整个孕期HbA1c维持在同一水平。其他各组(第2组:6.5%[48 mmol/mol]~7.9%[63 mmol/mol], 第3组:8%[64 mmol/mol]~9.9%[86 mmol/mol], 第4组:>10%[86 mmol/mol]), 早孕时HbA1c下降, 但中期以后稳定。在四组中, 第一组在整个妊娠期间的每日胰岛素需求量最低( P =0.001)。出生体重与孕前HbA1c呈倒U型关系。第4组的平均孕长明显短于第1组( P =0.001)。 结论: 在这个较大的队列中, 我们发现孕前HbA1c较高是妊娠期血糖控制较差的预测因子, 而HbA1c在妊娠中期下降, 然后进入平台期。极高的孕前HbA1c与较短的孕长和较低的出生体重有关, 这与血糖控制不佳会导致较高出生体重的普遍假设相反。