Correlation between pre-delivery glycated hemoglobin Alc level and pregnancy outcome in patients with gestational diabetes mellitus / 中国基层医药

ABSTRACT

Objective:To investigate the relationship between pre-delivery glycated hemoglobin A1c (HbA1c) level and pregnancy outcome in patients with gestational diabetes mellitus (GDM).Methods:A total of 200 GDM patients who received treatment in Zhuji Maternal and Child Health Hospital, China between April 2018 and April 2020 were included in this study. All patients were subjected to health education, medical nutrition therapy, exercise intervention and necessary drug treatment. These patients were divided into GDM-1 (HbA1c > 7.0%, n = 30), GDM-2 (HbA1c 5.5%-7.0%, n = 30) and GDM-3 (HbA1c < 5.5%, n = 106) groups according to HbA1c levels within pre-delivery 1-3 days. An additional 400 healthy pregnant women who concurrently received health examination were included in the healthy control group (NC group). HbA1c level was compared between GDM patients and healthy controls. Pregnancy outcome was compared among patients with different HbA1c levels. Results:The incidences of pregnancy-induced hypertension, pathologic excess of amniotic fluid volume, cesarean section, asphyxia, neonatal hyperbilirubinemia, neonatal hypoglycemia, giant infant and premature delivery were significantly higher than those in the NC group ( χ2 = 4.59, 8.11, 9.19, 7.42, 10.05, 11.52, 35.75, 21.12, all P < 0.05). The incidences of pregnancy-induced hypertension, pathologic excess of amniotic fluid volume, cesarean section, asphyxia, neonatal hyperbilirubinemia, neonatal hypoglycemia, giant infant and premature delivery in the GDM-1 group were 10.00% (3/30), 30.00% (9/30), 33.33% (10/30), 26.67% (8/30), 30.00% (9/30), 36.67% (11/30), 50.00% (15/30), 30.00% (9/30), respectively, and they were 4.69% (3/64), 14.06% (9/64), 28.13% (18/64), 14.06% (9/64), 18.75% (12/64), 18.75% (12/64), 39.06% (25/64), 15.63% (10/64), respectively in the GDM-2 group, and 0.94% (1/106), 6.60% (7/106), 14.15% (15/106), 9.43% (10/106), 4.72% (5/106), 4.72% (5/106), 18.87% (20/106), 9.43% (10/106), respectively in the GDM-3 group. There were significant differences in these indexes among the three groups ( χ2= 6.07, 11.91, 7.56, 5.97, 15.97, 21.59, 14.47, 8.07, all P < 0.05). Conclusion:Pre-delivery HbA1c level in GDM patients is related to pregnancy outcomes such as pregnancy-induced hypertension, pathologic excess of amniotic fluid volume, cesarean section, asphyxia, neonatal hyperbilirubinemia, neonatal hypoglycemia, giant infant and premature delivery. Strict control of blood glucose is of great significance to improve the outcomes of pregnant patients with GDM and their newborns.