Elevated Hba1C During First Trimester Linked With Adverse Pregnancy Outcome
Gestational diabetes (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes including an increased risk for type 2 diabetes and cardiovascular disease later in life in mothers and an increased risk for macrosomia and obesity in offspring. However, a recent study suggests that elevated glycated haemoglobin (HbA1c) in the first trimester (HbA1c-FT) is linked with adverse pregnancy events in non-GDM Asian Indians. The updated study findings were published in the Journal of Diabetes and its Complications on April 13, 2022.
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".
For further information:
DOI: https://doi.org/10.1016/j.jdiacomp.2022.108187
