Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes.
Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes.
复制标题
患有孕前糖尿病的非西班牙裔黑人与白人女性怀孕期间糖化血红蛋白的差异。
DOI：
10.1055/a-1788-5600
复制
发表时间：
2022
影响因子：
2
通讯作者：
Joseph,JoshuaJ
中科院分区：
文献类型：
--
作者：
Venkatesh,KartikK;Fareed,Naleef;Kiefer,MirandaK;Ware,CourtneyA;Buschur,Elizabeth;Landon,MarkB;Thung,StephenF;Costantine,MagedM;Gabbe,StevenG;Joseph,JoshuaJ
本研究的目的是确定非西班牙裔黑人和白色妊娠前糖尿病妇女从妊娠早期到晚期血红蛋白A1 c（HbA 1 c）的变化是否不同。研究设计回顾性分析从2012年至2016年的综合产前和糖尿病护理计划进行。我们比较了HbA 1c作为一个连续的指标，其次，HbA 1c <6.5%，在早期（约10周）和晚期（约31周）怀孕的横断面和纵向。采用线性回归和逻辑回归分析，并根据年龄、体重指数、白色糖尿病分类、药物使用、糖尿病类型、基线HbA 1c测量时的胎龄和基线血红蛋白进行调整。（39%为1型，61%为2型），根据社会脆弱性指数（SVI）的衡量，黑人妇女更有可能经历社区一级健康的社会决定因素增加与白色女性相比，她们患1型糖尿病的可能性更小，患糖尿病的可能性更大（p< 0.05）。与白色女性相比，黑人女性的平均HbA 1c更高（7.8 vs. 7.4%; β：0.75; 95%置信区间[CI]：0.30-1.19），10周时HbA 1c < 6.5%的可能性更低（24 vs. 35%;校正比值比：0.45; 95% CI：0.24-0.81），但在校正SVI后并非如此。在31周时，两组的平均HbA 1c相似（均为6.5%），并且HbA 1c < 6.5%的可能性相同（57 vs. 54%）。从怀孕早期到晚期，黑人女性HbA 1c下降的百分比更高（1.3 vs. 0.9%; β = 0.63; 95% CI：0.27-0.99），并且从10至31周同样可能具有改善或稳定的HbA 1C < 6.5%，两组的平均HbA 1c相似（6.5%）在31周。结论尽管经历了更大的社区层面的社会健康决定因素，患有孕前糖尿病的黑人女性HbA 1c降低幅度更大，并且能够同样达到HbA 1c < 6.5%的目标。与白色妇女相比，作为糖尿病和产前综合护理计划的一部分，妊娠晚期妇女的糖尿病发病率下降了10%。
ObjectiveThe objective of this was to determine whether the change in hemoglobin A1c (HbA1c) from early to late pregnancy differs between non-Hispanic Black and White women with prepregnancy diabetes.Study DesignA retrospective analysis was performed from an integrated prenatal and diabetes care program from 2012 to 2016. We compared HbA1c as a continuous measure and secondarily, HbA1c <6.5%, cross-sectionally, and longitudinally in early (approximately 10 weeks) and late (approximately 31 weeks) pregnancies. Linear and logistic regression were used and adjusted for age, body mass index, White diabetes class, medication use, diabetes type, gestational age at baseline HbA1c measurement, and baseline hemoglobin.ResultsAmong 296 non-Hispanic Black (35%) and White pregnant women (65%) with prepregnancy diabetes (39% type 1 and 61% type 2), Black women were more likely to experience increased community-level social determinants of health as measured by the Social Vulnerability Index (SVI) and were less likely to have type 1 diabetes and have more severe diabetes versus White women (p< 0.05). Black women had higher mean HbA1c (7.8 vs. 7.4%; beta: 0.75; 95% confidence interval [CI]: 0.30–1.19) and were less likely to have HbA1c < 6.5% at 10 weeks compared with White women (24 vs. 35%; adjusted odds ratio: 0.45; 95% CI: 0.24–0.81) but not after adjusting for SVI. At 31 weeks, both groups had similar mean HbA1c (both 6.5%) and were equally as likely to have HbA1c < 6.5% (57 vs. 54%). From early to late pregnancy, Black women had a higher percentage decrease in HbA1c (1.3 vs. 0.9%; beta = 0.63; 95% CI: 0.27–0.99) and were equally as likely to have an improvement or stable HbA1C < 6.5% from 10 to 31 weeks, with both groups having a similar mean HbA1c (6.5%) at 31 weeks.ConclusionDespite experiencing greater community-level social determinants of health, Black women with pregestational diabetes had a larger reduction in HbA1c and were able to equally achieve the target of HbA1c < 6.5% by late pregnancy compared with White women as part of an integrated diabetes and prenatal care program.Key Points