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.

中文翻译：

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2 型糖尿病女性妊娠期间的糖化血红蛋白轨迹和不良后果：丹麦全国人群队列研究


目的 识别和描述妊娠期间具有不同糖化血红蛋白 (HbA1c) 轨迹的 2 型糖尿病孕妇群体，并检查其与不良产科和围产期结局的关联。研究设计和方法 这是一项回顾性丹麦国家队列研究，包括 2004 年至 2019 年间所有产下活产婴儿的 2 型糖尿病女性单胎妊娠。使用潜在类线性混合模型分析确定 HbA1c 轨迹。使用逻辑回归模型检查与不良结果的关联。结果 总共纳入了 1,129 例妊娠。根据妊娠早期血糖控制情况确定并命名三个 HbA1c 轨迹组（良好，59%；中等，32%；差，9%）。根据该模型，所有组在怀孕期间均达到估计的 HbA1c <6.5% (48 mmol/mol)，在妊娠第三个月各组之间没有差异。妊娠早期血糖控制不佳的女性生出大于胎龄 (LGA) 出生体重的婴儿的几率较低（调整后优势比 [aOR] 0.57，95% CI 0.40–0.83），而生出大于胎龄 (LGA) 出生体重的婴儿的几率较高与血糖控制良好的女性相比，小于胎龄（SGA）出生体重（aOR 2.49，95% CI 2.00–3.10）和先天性畸形（CM）（aOR 4.60 95% CI 3.39–6.26）。没有证据表明各组之间先兆子痫、早产和剖腹产的几率存在差异。结论 妊娠早期血糖控制不佳的女性生出 LGA 出生体重婴儿的几率较低，但生出 SGA 出生体重和 CM 婴儿的几率较高。