Hemoglobin A1c Trajectories During Pregnancy and Adverse Outcomes in Women With Type 2 Diabetes: A Danish National Population-Based Cohort Study.

Autor:	Koefoed AS; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Knorr S; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Fuglsang J; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Leth-Møller M; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Hulman A; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Public Health, Aarhus University, Aarhus, Denmark., Jensen DM; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark., Andersen LLT; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark., Rosbach AE; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark., Damm P; Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Mathiesen ER; Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Sørensen A; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Christensen TT; Steno Diabetes Center Aalborg, Aalborg University Hospital, Aalborg, Denmark., McIntyre HD; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia., Ovesen P; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Kampmann U; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2024 Jul 01; Vol. 47 (7), pp. 1211-1219.
DOI:	10.2337/dc23-2304
Abstrakt:	Objective: To identify and characterize groups of pregnant women with type 2 diabetes with distinct hemoglobin A1c (HbA1c) trajectories across gestation and to examine the association with adverse obstetric and perinatal outcomes. Research Design and Methods: This was a retrospective Danish national cohort study including all singleton pregnancies in women with type 2 diabetes, giving birth to a liveborn infant, between 2004 and 2019. HbA1c trajectories were identified using latent class linear mixed-model analysis. Associations with adverse outcomes were examined with logistic regression models. Results: A total of 1,129 pregnancies were included. Three HbA1c trajectory groups were identified and named according to the glycemic control in early pregnancy (good, 59%; moderate, 32%; and poor, 9%). According to the model, all groups attained an estimated HbA1c <6.5% (48 mmol/mol) during pregnancy, with no differences between groups in the 3rd trimester. Women with poor glycemic control in early pregnancy had lower odds of having an infant with large-for-gestational-age (LGA) birth weight (adjusted odds ratio [aOR] 0.57, 95% CI 0.40-0.83), and higher odds of having an infant with small-for-gestational age (SGA) birth weight (aOR 2.49, 95% CI 2.00-3.10) and congenital malformation (CM) (aOR 4.60 95% CI 3.39-6.26) compared with women with good glycemic control. There was no evidence of a difference in odds of preeclampsia, preterm birth, and caesarean section between groups. Conclusions: Women with poor glycemic control in early pregnancy have lower odds of having an infant with LGA birth weight, but higher odds of having an infant with SGA birth weight and CM. (© 2024 by the American Diabetes Association.)
Databáze:	MEDLINE
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