Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control.
Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control.
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在具有良好的1型糖尿病和良好血糖控制的女性中，大糖症的风险仍然依赖于葡萄糖。
DOI：
10.1007/s12020-016-1134-z
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发表时间：
2017-02
期刊：
影响因子：
3.7
通讯作者：
Malecki MT
中科院分区：
文献类型：
--
作者：
Cyganek K;Skupien J;Katra B;Hebda-Szydlo A;Janas I;Trznadel-Morawska I;Witek P;Kozek E;Malecki MT
1型糖尿病（T1 DM）合并妊娠的巨大儿风险仍然很高。描述了巨大儿风险与糖化血红蛋白A1 c（HbA 1c）之间的线性关系;然而，尚未研究HbA 1c的低范围。我们的目的是确定风险因素，并检查HbA 1c对血糖控制良好的T1 DM女性新生儿发生巨大儿的影响。在这项观察性回顾性单中心研究中，我们分析了510例连续T1 DM妊娠的记录（1998-2012年）。分析组包括375例足月单胎妊娠。我们使用多元回归模型来研究HbA 1c和自我监测的血糖在每三个月的巨大儿和出生体重的风险的影响。T1 DM女性的中位年龄为28岁，中位T1 DM病程为11年，中位孕前BMI为23.3 kg/m2。中位出生体重达到3520 g（第一和第三四分位数分别为3150和3960），在中位妊娠39周。巨大儿（>4000 g）85例（22.7%）.妊娠早期、妊娠中期和妊娠晚期的中位HbA 1c水平分别为6.4%、5.7%和5.6%。妊娠晚期HbA 1c、平均空腹血糖和母亲年龄是出生体重和巨大儿的独立预测因素。妊娠晚期HbA 1c在4.5%~ 7.0%范围内与巨大儿风险呈线性关系。尽管代谢控制良好，但T1 DM母亲的巨大儿很常见。妊娠晚期的血糖升高是导致这种情况的主要原因。
Macrosomia risk remains high in type 1 diabetes (T1DM) complicated pregnancies. A linear relationship between macrosomia risk and glycated hemoglobin A1c (HbA1c) was described; however, low range of HbA1c has not been studied. We aimed to identify risk factors and examine the impact of HbA1c on the occurrence of macrosomia in newborns of T1DM women from a cohort with good glycemic control. In this observational retrospective one-center study we analyzed records of 510 consecutive T1DM pregnancies (1998–2012). The analyzed group consisted of 375 term singleton pregnancies. We used multiple regression models to examine the impact of HbA1c and self-monitored glucose in each trimester on the risk of macrosomia and birth weight. The median age of T1DM women was 28 years, median T1DM duration—11 years, median pregestational BMI—23.3 kg/m2. Median birth weight reached 3520 g (1st and 3rd quartiles 3150 and 3960, respectively) at median 39 weeks of gestation. There were 85 (22.7 %) macrosomic (>4000 g) newborns. Median HbA1c levels in the 1st, 2nd, and 3rd trimester were 6.4, 5.7, and 5.6 %. Third trimester HbA1c, mean fasting self-monitored glucose and maternal age were independent predictors of birth weight and macrosomia. There was a linear relationship between 3rd trimester HbA1c and macrosomia risk in HbA1c range from 4.5 to 7.0 %. Macrosomia in children of T1DM mothers was common despite excellent metabolic control. Glycemia during the 3rd trimester was predominantly responsible for this condition.