Glycated hemoglobin in pregnancies at increased risk for gestational diabetes mellitus

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• 作者：Johan Verhaeghe^a ; ^{johan.verhaeghe@uz.kuleuven.be} ; Erik Van Herck^b ; Katrien Benhalima^c ; Chantal Mathieu^c
• 关键词：Gestational diabetes mellitus ; Glycated hemoglobin ; Insulin resistance ; Insulin secretion
• 刊名：European Journal of Obstetrics and Gynecology and Reproductive Biology
• 出版年：2012
• 期刊代码：92_03012115
• 类别：med
• 出版时间：April, 2012
• 卷：161
• 期：2
• 页码：157-162
• 文件大小：576 K

摘要

Objective

The glycated hemoglobin (HbA_1c) value is increasingly used for the detection of (pre)diabetes, but HbA_1c decreases during pregnancy. We sought to identify clinical and metabolic correlates of HbA_1c in pregnancies at increased risk for gestational diabetes mellitus (GDM).

Study design

We prospectively studied 335 gravidas who received a 3-h 100 g oral glucose tolerance test (OGTT) at 24-32 weeks, in most cases after an abnormal glucose challenge test. Several indices of insulin sensitivity and secretion were computed from fasting measurements and the OGTT.

Results

HbA_1c concentrations gradually increased in diet-treated and insulin-treated GDM gravidas compared with non-GDM gravidas. HbA_1c was higher if the insulin peak was delayed until 180 min compared with 60 or 120 min. Stepwise regression identified the homeostasis modeling assessment of insulin resistance (HOMA-IR) as the first-rank correlate. Other correlates were ethnicity, a low insulin-to-glucose response at 60 min, and gestational age. The HbA_1c value corresponding to a fasting glucose of 5.1 mmol/l (diagnostic of GDM) was 2 mmol/mol (鈭?.2%) higher if sampling occurred at 29-32 vs. 24-28 weeks or if ancestry was non-European vs. European.

Conclusion

HbA_1c is strongly associated with insulin resistance; in addition, HbA_1c captures the first-phase insulin response. However, HbA_1c varies with gestational age and ethnicity.