Lowering HbA1c during pregnancy may reduce risks for adverse neonatal outcomes
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By reducing HbA1c during pregnancy, women with pregestational diabetes may reduce their risks for having an infant born large for gestational age or with neonatal hypoglycemia, according to study results published in Diabetic Medicine.
“Pregnant women with pregestational diabetes who achieve a reduction in HbA1c during pregnancy have a decreased risk of having an infant born large for gestational age or with neonatal hypoglycemia,” Miranda Kiefer, DO, a fellow in the division of maternal-fetal medicine, department of obstetrics and gynecology at The Ohio State University, and colleagues wrote. “These results suggest that net improvement in HbA1c from early to late pregnancy may be an additional measure to assess glycemic control beyond self-monitoring of blood glucose and may also stratify the risk of adverse pregnancy outcomes associated with maternal dysglycemia.”
Researchers conducted a retrospective cohort study of 347 women with type 1 or type 2 pregestational diabetes attending The Ohio State University Wexner Medical Center from 2012 to 2016. Women with a diabetes diagnosis or an HbA1c higher than 6.5% within 12 weeks of their last menstrual period were included. Early pregnancy included HbA1c values collected during the first 19 weeks of gestation, and late pregnancy included HbA1c collected at 20 weeks or later. Researchers analyzed the change in HbA1c from early to late pregnancy for each participant. The primary outcomes of the study were infants born large for gestational age or with neonatal hypoglycemia.
Of women included in the study, 65% had type 2 diabetes and 35% were diagnosed with type 1 diabetes. The cohort had a mean HbA1c reduction from 7.5% in early pregnancy to 6.4% in late pregnancy. Mean HbA1c was higher among women with type 1 diabetes vs. those with type 2 diabetes in late pregnancy (6.9% vs. 6.2%; P < .001), but there was no significant difference between diabetes types early in pregnancy.
Of the cohort, 30% had large for gestational age infants at birth and 35% had a newborn with neonatal hypoglycemia. Each 0.5% decrease in HbA1c from early pregnancy to late pregnancy was associated with a lower risk for having a large for gestational age infant (adjusted RR = 0.88; 95% CI, 0.81-0.95) or an infant with neonatal hypoglycemia (aRR = 0.93; 95% CI, 0.87-0.99).
Preterm births less than 37 weeks after the start of pregnancy were observed in 36% of infants, and 55% of infants were admitted to the neonatal ICU at birth. Each 0.5% decrease in HbA1c from early to late pregnancy lowered a woman’s risk for having a preterm birth (aRR = 0.93; 95% CI, 0.89-0.98) or having their infant admitted to the neonatal ICU (aRR = 0.95; 95% CI, 0.91-0.98).
“A reduction in HbA1c across pregnancy may be a useful measure of response to clinical interventions aimed at glycemic control and may also signify a reduction in the risk of adverse perinatal outcomes at delivery,” the researchers wrote. “However, it is important to note that trials have not been conducted to demonstrate the risks and benefits of using HbA1c targets in pregnancy for glycemic control. In addition, further research is needed to define whether a net decline in HbA1c vs. achieving a threshold value is most predictive of reducing the risk of adverse pregnancy outcomes, and at what specific time points HbA1c should be assessed.”
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