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Adverse pregnancy outcomes tied to early HbA1c levels
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The risk for adverse pregnancy outcomes is increased in women with an early HbA1c of at least 5.9% regardless of a gestational diabetes diagnosis later in pregnancy, according to recent study findings.
Juana Antonia Flores-Le Roux, PhD, department of endocrinology and nutrition, Hospital del Mar in Spain, and colleagues evaluated data on 1,228 pregnant women from the Hospital del Mar from April 2013 to September 2015 to determine whether an early HbA1c of at least 5.9% can identify women at increased risk for adverse pregnancy outcomes.
Participants were screened for gestational diabetes at 24 to 28 weeks’ gestation, and HbA1c measurement was added to first antenatal blood tests. The primary outcome of the study was macrosomia, and secondary outcomes included rates of preeclampsia, preterm birth and caesarean section.
Compared with participants with an HbA1c less than 5.9% (n = 48), participants with an HbA1c of at least 5.9% (n = 1,180) were more often members of ethnic minorities, had higher prepregnancy BMI, were more likely to have anemia and microcytosis, and were more likely to be diagnosed with gestational diabetes.
The rate of macrosomia was increased nearly threefold in participants with HbA1c of at least 5.9% compared with participants with HbA1c less than 5.9%; there also was an increased tendency toward preeclampsia. The rates of preterm birth and caesarean section did not differ significantly between the two groups.
Among participants with HbA1c of at least 5.9%, 22 were diagnosed and treated for gestational diabetes.
Researchers observed an independent association between an HbA1c cutoff of at least 5.9% and a higher risk for macrosomia (P = .028) and preeclampsia (P = .036).
“In a multiethnic population, an early HbA1c 5.9% ( 41 mmol/mol) measurement identifies a group of women at high risk for poorer pregnancy outcomes regardless of a subsequent [gestational diabetes] diagnosis later in pregnancy, who could benefit from early intervention,” the researchers wrote. “We consider HbA1c to be a helpful addition to the initial antenatal blood testing to evaluate the risk of adverse obstetric results; however, further large-scale studies are required to establish cutoff points adapted to each ethnic group and assess whether early detection and treatment are of benefit.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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