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Title: [High level of hemoglobin during the first trimester of pregnancy associated with the risk of gestational diabetes mellitus].
Author: Gao CJ, Huang XM, Chen ZP, Sheng L, Xu J, Li Y, Li XY, Zhang R, Yu ZY, Zha BB, Wu YY, Yang M, Ding HY, Sun TG, Zhang YQ, Ma L, Liu J.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2019 Oct 25; 54(10):654-659. PubMed ID: 31648440.
Abstract:
Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM. 目的： 探讨妊娠早期血红蛋白（Hb）水平与妊娠期糖尿病（GDM）发生的关系。 方法： 收集2016年1月至2018年5月于上海市闵行区中西医结合医院和复旦大学附属上海市第五人民医院进行规律产前检查的单胎孕妇共1 276例，其中GDM者99例（GDM组），正常孕妇1 177例（对照组）；再按照妊娠早期Hb水平，分为低Hb水平（即Hb<110 g/L）组236例，正常Hb水平（110 g/L≤Hb<130 g/L）组868例，高Hb水平（Hb≥130 g/L）组172例。记录所有孕妇的临床资料，包括妊娠早期血常规，妊娠中期口服葡萄糖耐量实验（OGTT）血糖水平、空腹胰岛素水平；采用稳态模型评估的胰岛素抵抗指数（HOMA-IR）和稳态模型评估的胰岛β细胞功能指数（HOMA-β）评价孕妇的胰岛素抵抗及胰岛β细胞功能。 结果： （1）GDM组孕妇的妊娠早期Hb水平明显高于对照组[分别为（123±10）、（119±11）g/L；P<0.05]，两组孕妇的孕次、产次及妊娠早期肝肾功能、HOMA-β，分别比较，差异均无统计学意义（P均>0.05）。（2）高Hb水平组、正常Hb水平组、低Hb水平组孕妇的妊娠前体质指数（BMI）[分别为（23±4）、（22±3）、（22±3）kg/m(2)]，OGTT的1 h[（7.3±2.0）、（6.7±1.6）、（6.5±1.5）mmol/L]和2 h血糖水平[（6.5±1.4）、（6.1±1.2）、（5.9±1.1）mmol/L]，分别比较，差异均有统计学意义（P均<0.05）；而3组孕妇的空腹血糖水平、空腹胰岛素水平、HOMA-IR及HOMA-β分别比较，差异均无统计学意义（P均>0.05）。高Hb水平组孕妇的妊娠前超重或肥胖者的比例（37.2%，64/172）及GDM的发生率（15.1%，26/172）均最高，3组比较，差异均有统计学意义（P均<0.01）。（3）妊娠早期Hb水平与妊娠前BMI（r=0.130）、OGTT 1 h血糖水平（r=0.129）、2 h血糖水平（r=0.134）、空腹胰岛素水平（r=0.096）及HOMA-IR（r=0.101）均呈正相关（P均<0.05）。logistic回归分析显示，妊娠早期高Hb水平是发生GDM的独立风险因素（OR=2.799，95%CI为1.186~6.604；P<0.05）。 结论： 妊娠早期高Hb水平（Hb≥130 g/L）与GDM发生相关。.

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