Titre du document / Document title

HbA_1c in early diabetic pregnancy and pregnancy outcomes : A Danish population-based cohort study of 573 pregnancies in women with type 1 diabetes

Auteur(s) / Author(s)

NIELSEN Gunnar L. ^{(1 2)} ; MØLLER Margrethe ⁽³⁾ ; SØRENSEN Henrik T. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, DANEMARK
⁽²⁾ Department of Clinical Biochemistry, Aalborg Hospital, Aarhus University Hospital, Aalborg, DANEMARK
⁽³⁾ Department of Obstetrics and Gynecology, Aalborg Hospital, Aarhus University Hospital, Aalborg, DANEMARK

Résumé / Abstract

OBJECTIVE- To assess the association between first-trimester HbA_1c (AlC) and the risk of adverse pregnancy outcomes in type 1 diabetic pregnancies. RESEARCH DESIGN AND METHODS - We identified all pregnant diabetic women in a Danish county from 1985 to 2003. AlC values from first trimester were collected, and pregnancy outcome was dichotomized as good (i.e., babies surviving the 1st month of life without major congenital abnormalities) and adverse (i.e., spontaneous and therapeutic abortion, stillbirth, neonatal death, or major congenital abnormalities detected within the 1st month). The prevalence of adverse outcomes was calculated according to quintiles of AlC. We computed receiver operating characteristic and lowess curve estimates and fitted logistic regression models to calculate prevalence odds ratio while adjusting for confounding by White class and smoking status. RESULTS- Of 573 pregnancies, 165 (29%) terminated with adverse outcomes. The prevalence of adverse outcomes varied sixfold from 12% (95% CI 7.2-17) in the lowest to 79% (60-91) in the highest quintile of AlC exposure. From AlC levels >7%, we found an almost linear association between AlC and risk of adverse outcome, whereby a 1% increase in AlC corresponded to 5.5% (3.8-7.3) increased risk of adverse outcome. CONCLUSIONS- Starting from a first-trimester AlC level slightly <7%, there is a dose-dependent association between AlC and the risk of adverse pregnancy outcome without indication of a plateau, below which the association no longer exits. AlC, however, seems to be of limited value in predicting outcome in the individual pregnancy.

Revue / Journal Title

Diabetes care   ISSN 0149-5992   CODEN DICAD2 

Source / Source

2006, vol. 29, n^o12, pp. 2612-2616 [5 page(s) (article)] (19 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Diabetes Association, Alexandria, VA, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Immunopathology ; Autoimmune disease ; Endocrinopathy ; Europe ; Woman ; Adult ; Human ; Cohort study ; Maternal diseases ; Denmark ; Prognosis ; Female ; Early pregnancy ; Hemoglobin A1c ; Type 1 diabetes ;

Mots-clés français / French Keywords

Immunopathologie ; Maladie autoimmune ; Endocrinopathie ; Europe ; Femme ; Adulte ; Homme ; Etude cohorte ; Mère pathologie ; Danemark ; Pronostic ; Femelle ; Gestation début ; Hémoglobine A1c ; Diabète type 1 ;

Mots-clés espagnols / Spanish Keywords

Inmunopatología ; Enfermedad autoinmune ; Endocrinopatía ; Europa ; Mujer ; Adulto ; Hombre ; Estudio cohorte ; Madre patología ; Dinamarca ; Pronóstico ; Hembra ; Gestación principio ; Hemoglobina A1c ; Diabetes de tipo 1 ;

Localisation / Location

INIST-CNRS, Cote INIST : 18054, 35400014508528.0070