HbA1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study
HbA1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study
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DOI：
10.1007/s00125-012-2721-z
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发表时间：
2012-12-01
期刊：
影响因子：
8.2
通讯作者：
Bell, R.
中科院分区：
文献类型：
--
作者：
Glinianaia, S. V.;Tennant, P. W. G.;Bell, R.
旨在调查 1 型或 2 型糖尿病女性所生单胎出生体重的临床和社会人口学预测因素。根据基于人口的北方妊娠期糖尿病调查 (n = 1,505)，确定了 1996 年至 2008 年间患有孕前糖尿病的女性所生的正常单胎活产和产时死产。通过多元回归分析潜在预测因素和出生体重之间的关联。出生体重增加的潜在可修改独立预测因素是孕前护理（调整后的回归系数[b] = 87.1 g；95% CI 12.9, 161.3）、妊娠晚期 HbA(1c) 千分之一货币符号7%（53 mmol/mol）的增加（b = 310.5 g/1%[11] mmol/mol]；95% CI 246.3, 374.7) 和母亲 BMI 增加（b = 9.5 g/1 kg/m(2)；95% CI 3.5, 15.5）。妊娠期间吸烟 (b = -145.1 g; 95% CI -231.4, -58.8)、第一次产前检查时妊娠较晚 (b = -15.0 g; 95% CI -26.9, -3.0) 和围孕期 HbA(1c) 较高 (b = -48.2 g; 95% CI -68.8, -27.6) 与出生体重减少。孕前肾病（b = -282.7 g；95% CI -461.8，-103.6）和视网膜病变（b = -175.5 g；95% CI -269.9，-81.0）是出生体重减少的独立、不可改变的预测因素，而母亲身高较高是出生体重增加的不可改变的预测因素（b = 17.8 g；95% CI） 12.3、23.2）。出生体重增加的其他预测因素包括男性、多胎和分娩时胎龄的增加。糖尿病的类型或持续时间、社会经济状况和种族与持续出生体重无关。孕前和整个孕期血糖控制不佳与胎儿生长异常相关，围孕期 HbA(1c) 升高预示体重减轻，妊娠晚期 HbA(1c) 升高预示出生体重增加。患有糖尿病微血管并发症的女性可能需要加强监测以发现胎儿生长受限。
To investigate clinical and sociodemographic predictors of birthweight in singletons born to women with type 1 or type 2 diabetes.Normally formed singleton live births and intrapartum stillbirths, born to women with pre-conception diabetes during 1996-2008, were identified from the population-based Northern Diabetes in Pregnancy Survey (n = 1,505). Associations between potential predictors and birthweight were analysed by multiple regression.Potentially modifiable independent predictors of increase in birthweight were pre-pregnancy care (adjusted regression coefficient [b] = 87.1 g; 95% CI 12.9, 161.3), increasing third-trimester HbA(1c) a parts per thousand currency sign7% (53 mmol/mol) (b = 310.5 g per 1% [11 mmol/mol]; 95% CI 246.3, 374.7) and increasing maternal BMI (b = 9.5 g per 1 kg/m(2); 95% CI 3.5, 15.5). Smoking during pregnancy (b = -145.1 g; 95% CI -231.4, -58.8), later gestation at first antenatal visit (b = -15.0 g; 95% CI -26.9, -3.0) and higher peri-conception HbA(1c) (b = -48.2 g; 95% CI -68.8, -27.6) were independently associated with birthweight reduction. Pre-pregnancy nephropathy (b = -282.7 g; 95% CI -461.8, -103.6) and retinopathy (b = -175.5 g; 95% CI -269.9, -81.0) were independent non-modifiable predictors of reduced birthweight, while greater maternal height was a non-modifiable predictor of increasing birthweight (b = 17.8 g; 95% CI 12.3, 23.2). Other predictors of birthweight increase were male sex, multiparity and increasing gestational age at delivery. Type or duration of diabetes, socioeconomic status and ethnicity were not associated with continuous birthweight.Poor glycaemic control before and throughout pregnancy is associated with abnormal fetal growth, with increasing peri-conception HbA(1c) predicting weight reduction and increasing third-trimester HbA(1c) predicting increased birthweight. Women with microvascular complications of diabetes may require increased surveillance to detect fetal growth restriction.