Longitudinal Changes in the Relationship Between Hemoglobin A1c and Glucose Tolerance Across Pregnancy and Postpartum
Longitudinal Changes in the Relationship Between Hemoglobin A1c and Glucose Tolerance Across Pregnancy and Postpartum
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DOI：
10.1210/clinem/dgaa053
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发表时间：
2020-05-01
影响因子：
5.8
通讯作者：
Powe, Camille E.
中科院分区：
文献类型：
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作者：
Edelson, P. Kaitlyn;James, Kaitlyn E.;Powe, Camille E.
目的：为了描述血红蛋白A1 c（HbA 1c）水平与妊娠期和产后葡萄糖耐量之间的关系。设计和参与者：在一项对有妊娠期糖尿病危险因素的孕妇（N = 102）的纵向研究中，我们在妊娠10-15周、24-30周（N = 73）、产后6-24周（N = 42）。从临床记录中获得全血细胞计数。我们计算HbA 1c估计的平均血糖水平，并将其与平均OGTT血糖水平（空腹、1小时和2小时血糖水平的平均值）进行比较。结果：平均OGTT葡萄糖在妊娠10-15周和24-30周之间增加（β = 8.1 mg/dL，P = 0.001），而HbA 1c在同一时间段内下降（β =-0.13%，P <0.001）。在妊娠10-15周和产后，平均OGTT葡萄糖和HbA 1c估计的平均葡萄糖之间的差异极小（平均值[标准差]：1.2 [20.5] mg/dL和0.16 [18.1] mg/dL）。在妊娠24-30周，差异扩大（13.2 [17.9] mg/dL，β = 12.7 mg/dL，P <0.001，与妊娠10-15周相比，平均OGTT葡萄糖高于HbA 1c估计的平均葡萄糖）。在孕24-30周时血红蛋白较低与更大的差异相关（β = 6.4 mg/dL/1 g/dL血红蛋白较低，在年龄和胎龄调整的线性回归模型中P = 0.03）。结论：HbA 1c准确反映了妊娠早期的血糖水平，但低估了妊娠后期的葡萄糖耐受不良。较低的血红蛋白水平与更大的低估有关。考虑胎龄和母体血红蛋白可能会改善妊娠期间HbA 1c水平的临床解释。
Objective: To characterize the relationship between hemoglobin A1c (HbA1c) levels and glucose tolerance across pregnancy and postpartum.Design and Participants: In a longitudinal study of pregnant women with gestational diabetes risk factors (N = 102), we performed oral glucose tolerance testing (OGTT) and HbA1c measurements at 10-15 weeks of gestation, 24-30 weeks of gestation (N = 73), and 6-24 weeks postpartum (N = 42). Complete blood counts were obtained from clinical records. We calculated HbA1c-estimated average glucose levels and compared them with mean OGTT glucose levels (average of fasting, 1- and 2-hour glucose levels). Linear mixed effects models were used to test for longitudinal changes in measurements.Results: Mean OGTT glucose increased between 10-15 and 24-30 weeks of gestation (beta = 8.1 mg/dL, P = .001), while HbA1c decreased during the same time period (beta = -0.13%, P < .001). At 10-15 weeks of gestation and postpartum the discrepancy between mean OGTT glucose and HbA1c-estimated average glucose was minimal (mean [standard deviation]: 1.2 [20.5] mg/dL and 0.16 [18.1] mg/dL). At 24-30 weeks of gestation, the discrepancy widened (13.2 [17.9] mg/dL, beta = 12.7 mg/dL, P < .001, compared to 10-15 weeks of gestation, with mean OGTT glucose being higher than HbA1c-estimated average glucose). Lower hemoglobin at 24-30 weeks of gestation was associated with a greater discrepancy (beta = 6.4 mg/dL per 1 g/dL lower hemoglobin, P = .03 in an age- and gestational age-adjusted linear regression model).Conclusions: HbA1c accurately reflects glycemia in the 1st trimester, but underestimates glucose intolerance in the late 2nd trimester. Lower hemoglobin level is associated with greater underestimation. Accounting for gestational age and maternal hemoglobin may improve the clinical interpretation of HbA1c levels during pregnancy.