Relationship and predictive value of GA/HbA1c levels in late pregnancy and early neonatal hypoglycemia in pregnant women with gestational diabetes mellitus
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摘要:
目的 本研究旨在通过分析妊娠糖尿病(GDM)孕妇孕晚期糖化白蛋白/糖化血红蛋白的比值(GA/HbA1c)与新生儿早期低血糖的相关性，探讨该比值对新生儿低血糖发生风险的预测价值，以期为临床早期识别高危新生儿提供理论依据，以降低低血糖相关并发症的发生风险。 方法 选取2022年1月—2024年10月于湖州市妇幼保健院分娩的190例GDM孕妇，均检测孕晚期GA/HbA1c。将新生儿早期低血糖者纳入观察组(41例)，其余纳入对照组(149例)。采用logistic回归模型及森林图分析孕晚期GA/HbA1c与新生儿早期低血糖的关系，ROC曲线分析其预测价值。 结果 观察组新生儿出生30 min、12 h、24 h血糖水平均低于对照组(P＜0.05)。观察组孕妇孕晚期GA、GA/HbA1c高于对照组(P＜0.05)。无调整因素条件下，GA和GA/HbA1c每升高1个单位新生儿早期低血糖风险分别增加0.592倍、1.087倍。调整新生儿出生孕周、出生体重后，GA和GA/HbA1c每升高1个单位新生儿早期低血糖风险分别增加0.641倍、0.912倍。GDM孕妇孕晚期GA和GA/HbA1c预测新生儿早期低血糖的AUC分别为0.739、0.855，GA/HbA1c预测新生儿早期低血糖的AUC大于GA单独预测(Z=2.017，P=0.044)。 结论 GDM孕妇孕晚期GA/HbA1c水平升高是新生儿早期低血糖的危险因素，孕晚期GA/HbA1c有望作为预测新生儿早期低血糖的潜在指标。 Abstract:Objective This study endeavors to investigate the correlation between the ratio of glycated albumin to glycated hemoglobin (GA/HbA1c) in the third trimester of gestational diabetes mellitus (GDM) pregnancies and the occurrence of early neonatal hypoglycemia, and to investigate the value of this ratio in predicting the risk of neonatal hypoglycemia. This could offer a theoretical foundation for the early clinical identification of high-risk newborns and contribute to reducing complications associated with hypoglycemia. Methods A total of 190 pregnant women with GDM were selected from Huzhou Maternity & Child Care Hospital from January 2022 to October 2024. GA and HbA1c levels were detected in the third trimester, and the GA/HbA1c ratio was calculated. The patients with early neonatal hypoglycemia were included in the observation group (n=41), while the remaining patients were included in the control group (n=149). A logistic regression model and forest plot analysis were used to examine the relationship between GA/HbA1c in late pregnancy and early neonatal hypoglycemia. The receiver operating characteristic (ROC) curve was used to assess its predictive value. Results The blood glucose level at 30 min, 12 h, and 24 h in the observation group were lower than those in the control group, respectively (P < 0.05). The GA and GA/HbA1c ratio in the observation group were higher than those in the control group (P < 0.05). Without adjustment for confounding factors, each unit increase in GA and GA/HbA1c was associated with a 0.592-fold and 1.087-fold increase in the risk of early neonatal hypoglycemia, respectively. After adjusting for gestational weeks and birth weight of newborns, each unit increase in GA and GA/HbA1c was associated with a 0.641-fold and 0.912-fold, respectively. The AUC values of GA and GA/HbA1c in predicting early neonatal hypoglycemia in the third trimester of GDM were 0.739 and 0.855, respectively. The AUC values for GA/HbA1c in predicting early neonatal hypoglycemia were greater than those for GA alone (Z=2.017, P=0.044). Conclusion The increase of GA/HbA1c level in women with GDM in the third trimester is a risk factor for early neonatal hypoglycemia. The GA/HbA1c ratio in the third trimester is expected to be a potential indicator for predicting early neonatal hypoglycemia. -
图 1 GDM孕妇孕晚期GA、GA/HbA1c预测新生儿早期低血糖的ROC曲线
Figure 1. ROC curve for predicting early neonatal hypoglycemia using GA and GA/HbA1c in the third trimester of GDM pregnancies
表 1 2组新生儿出生后血糖水平比较(x±s，mmol/L)
Table 1. Comparison of blood glucose levels in neonates after birth between two groups (x±s, mmol/L)
组别 例数 出生30 min 出生12 h 出生24 h 观察组 41 3.19±0.48 3.41±0.47 3.79±0.52 对照组 149 3.60±0.52 3.86±0.49 4.19±0.55 F值 10.386 12.457 13.829 P值 ＜0.001 ＜0.001 ＜0.001 注：F时间=10.359、F组别=12.866、F交互=22.791，均P＜0.001。 
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表 2 2组孕妇孕晚期GA、HbA1c、GA/HbA1c比较(x±s)
Table 2. Comparison of GA, HbA1c, and GA/HbA1c levels in the third trimester between two groups of pregnant women (x±s)
组别 例数 GA(%) HbA1c(%) GA/HbA1c 观察组 41 14.28±2.57 5.66±1.23 2.55±0.21 对照组 149 12.03±2.46 5.52±1.31 2.20±0.26 t值 5.137 0.587 7.932 P值 ＜0.001 0.558 ＜0.001
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表 3 2组孕妇临床资料比较
Table 3. Comparison of clinical data between two groups of pregnant women
项目 观察组(n=41) 对照组(n=149) 统计量 P值 年龄(x±s，岁) 32.06±2.57 31.57±2.80 1.009a 0.314 孕前BMI(x±s) 24.52±2.25 23.98±2.42 1.284a 0.201 GDM确诊孕周(x±s，周) 26.12±1.34 25.94±1.41 0.731a 0.465 经产情况[例(%)] 0.424b 0.515 初产妇 25(60.98) 99(66.44) 经产妇 16(39.02) 50(33.56) 剖宫产史[例(%)] 0.063b 0.802 是 5(12.20) 18(12.08) 否 36(87.80) 131(87.92) 合并妊娠期高血压[例(%)] ＜0.001b 0.986 是 5(12.20) 16(10.74) 否 36(87.80) 133(89.26) 本次分娩方式[例(%)] 0.020b 0.887 阴道分娩 28(68.29) 100(67.11) 剖宫产 13(31.71) 49(32.89) 注：a为t值，b为χ2值。
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表 4 2组新生儿临床资料比较[例(%)]
Table 4. Comparison of clinical data between two groups of neonates
项目 观察组(n=41) 对照组(n=149) χ2值 P值 性别 0.005 0.942 男 22(53.66) 79(53.02) 女 19(46.34) 70(46.98) 出生孕周 5.945 0.015 ＜37周 14(34.15) 25(16.78) ≥37周 27(65.85) 124(83.22) 出生体重 6.807 0.009 ＜2 500 g 16(39.02) 29(19.46) ≥2 500 g 25(60.98) 120(80.54) 出生1 min Apgar评分 0.481 0.488 ≤7分 15(36.59) 46(30.87) ＞7分 26(63.41) 103(69.13)
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表 5 各变量赋值情况
Table 5. Variables assignment
变量 赋值方法 因变量 新生儿早期低血糖发生情况 否=0，是=1 自变量 出生孕周 ＜37周=1，≥37周=2 出生体重 ＜2 500 g=1，≥2 500 g=2 GA 连续性变量，以实际值赋值 GA/HbA1c 连续性变量，以实际值赋值
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表 6 新生儿早期低血糖的影响因素分析
Table 6. Analysis of factors influencing early neonatal hypoglycemia
变量 B SE Waldχ2 P值 OR值 95% CI 模型1 出生孕周 -1.444 0.606 5.688 0.017 0.236 0.072~0.773 出生体重 -1.532 0.563 7.414 0.006 0.216 0.072~0.651 GA 0.465 0.124 14.102 ＜0.001 1.592 1.249~2.029 GA/HbA1c 0.736 0.132 31.193 ＜0.001 2.087 1.612~2.701 模型2 GA 0.495 0.115 18.543 ＜0.001 1.641 1.310~2.056 GA/HbA1c 0.648 0.114 32.321 ＜0.001 1.912 1.529~2.391
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表 7 GDM孕妇孕晚期GA、GA/HbA1c对新生儿早期低血糖的预测价值
Table 7. Predictive value of GA and GA/HbA1c in the third trimester for early neonatal hypoglycemia in GDM pregnant women
项目 AUC 95% CI Z值 P值 cut-off值 Youden指数 灵敏度(%) 特异度(%) GA 0.739 0.670~0.800 5.203 ＜0.001 ＞13.56% 0.452 70.73 74.50 GA/HbA1c 0.855 0.797~0.902 11.315 ＜0.001 ＞2.34 0.627 90.24 72.48
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