Elevated Hba1C During First Trimester Linked With Adverse Pregnancy Outcome

HbA1c analysis was endorsed as a screening test for unrecognised diabetes in both the general population and in early pregnancy. A few prior studies have examined if HbA1c measured in the first trimester is useful for the early prediction of GDM. However, its significance in non-GDM individuals is understudied. Therefore, Dr John Punnose and his team conducted a study to determine the association of HbA1c-FT with adverse events among pregnant Asian Indian women without GDM.

In this retrospective cohort study, the researchers included 1618 pregnant women who delivered at a single urban tertiary care centre and had HbA1c-FT estimation between January 2011 and September 2017. They used multivariable logistic regression models to assess the association between elevated HbA1c-FT and adverse events.

Key findings of the study:

• Upon analysis, the researchers found that at a cutoff of ≥37 mmol/mol (5.5%), HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10).
• They observed that there was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol (0.5%) increase in HbA1c-FT for primary caesarean delivery: 1.27).
• Upon crude analysis, they found that gestational hypertension was associated with HbA1c-FT. However, not after adjustment for confounding factors.
• They reported that HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications).

The authors concluded, "Even without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women."

They further highlighted, "Mechanism of HbA1c-FT association with adverse events in non-GDM women is unclear".

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DOI: https://doi.org/10.1016/j.jdiacomp.2022.108187