Predelivery HbA1c Levels and Their Relationship with Adverse Perinatal Outcomes in Women with Normal 75-g OGTT

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2023 Dec 4

PMID 38047935

Authors

Xiaoxia Tang

Jin Wei

Zifeng Jiang

Shaohua Wu

Affiliations

Soon will be listed here.

Abstract

Purpose: To analyze the elevation of HbA1c before full-term delivery in single pregnancy with normal 75 g- Oral glucose tolerance test (OGTT) screening and its association with adverse perinatal outcomes.

Methods: From January to December 2022, an observational prospective study was conducted in a Single centre in China. 365 single pregnant women with normal OGTT were included in the study. HbA1c was measured during OGTT and before full-term delivery, and perinatal outcomes were collected. Participants' pre-delivery HBA1c values were analyzed and perinatal outcomes were compared. Logistic regression analysis was used for independent risk factors associated with elevated pre-delivery HbA1c ≥ 6.0%. The predictive value and truncation value were analyzed by ROC curve.

Results: 15.89% (58/365) of the Participants had a pre-delivery HBA1C value ≥ 6.0%. The incidence of neonatal asphyxia (13.79%, vs. 3.45%, vs. 2.26%, P = 0.007) and amniotic fluid fecal staining (29.31%, vs. 12.64%, vs. 12.03%, P = 0.004) were significantly increased in this group. The independent risk factor associated with pre-delivery HBA1c ≥ 6.0% was the fasting blood glucose(FBG) value of OGTT (OR = 51.308, 95% CI 12.93-203.67, P < 0.01) and the HBA1c value measured during OGTT (OR = 3.608, 95% CI 1.432-9.151, P = 0.007). When FBG was < 4.18 mmol/L and HBA1c was < 5.51%, The accuracy of predicting the pre-delivery HBA1c < 6.0% was 98.2%.

Conclusions: 15.89% of the single pregnancy with normal OGTT had HbA1c ≥ 6.0% before full-term delivery, and they had an increased incidence of neonatal asphyxia and amniotic fluid fecal staining. When the FBG ≥ 4.18 mmol/l or the HBA1c ≥ 5.51% during the OGTT screening, repeated OGTT were recommended in late pregnancy.

References

Kurtzhals L, Norgaard S, Secher A, Nichum V, Ronneby H, Tabor A . The impact of restricted gestational weight gain by dietary intervention on fetal growth in women with gestational diabetes mellitus. Diabetologia. 2018; 61(12):2528-2538. DOI: 10.1007/s00125-018-4736-6. View

Bianco M, Josefson J . Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes. Curr Diab Rep. 2019; 19(12):143. PMC: 7008468. DOI: 10.1007/s11892-019-1267-6. View

Plows J, Stanley J, Baker P, Reynolds C, Vickers M . The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018; 19(11). PMC: 6274679. DOI: 10.3390/ijms19113342. View

Fonseca A, Lopes J, Clode N . Glucose intolerance in the third trimester is not predictive of adverse outcomes. Int J Gynaecol Obstet. 2019; 147(1):108-114. DOI: 10.1002/ijgo.12923. View

Sohn J, Lim H, Kim S, Kim T, Kim B, Hwang K . Delayed diagnosis of gestational diabetes mellitus and perinatal outcomes in women with large for gestational age fetuses during the third trimester. Obstet Gynecol Sci. 2020; 63(5):615-622. PMC: 7494771. DOI: 10.5468/ogs.20007. View

Rayis D, Ahmed A, Sharif M, ElSouli A, Adam I . Reliability of glycosylated hemoglobin in the diagnosis of gestational diabetes mellitus. J Clin Lab Anal. 2020; 34(10):e23435. PMC: 7595906. DOI: 10.1002/jcla.23435. View

Dubey D, Kunwar S, Gupta U . Mid-trimester glycosylated hemoglobin levels (HbA1c) and its correlation with oral glucose tolerance test (World Health Organization 1999). J Obstet Gynaecol Res. 2019; 45(4):817-823. DOI: 10.1111/jog.13916. View

Renz P, Chume F, Timm J, Pimentel A, Camargo J . Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis. Clin Chem Lab Med. 2019; 57(10):1435-1449. DOI: 10.1515/cclm-2018-1191. View

Ryu A, Moon H, Na J, Kim Y, Kim S, Mo S . The Usefulness of the Glycosylated Hemoglobin Level for the Diagnosis of Gestational Diabetes Mellitus in the Korean Population. Diabetes Metab J. 2015; 39(6):507-11. PMC: 4696987. DOI: 10.4093/dmj.2015.39.6.507. View

10.

Tian Q, Xuan C, Wang H, Zhao J, Yu W, Gao G . Diagnostic accuracy of glycosylated hemoglobin in chinese patients with gestational diabetes mellitus: a meta-analysis based on 2,812 patients and 5,918 controls. Genet Test Mol Biomarkers. 2013; 17(9):687-95. DOI: 10.1089/gtmb.2013.0099. View

11.

Metzger B, Gabbe S, Persson B, Buchanan T, Catalano P, Damm P . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3):676-82. PMC: 2827530. DOI: 10.2337/dc09-1848. View

12.

Hughes R, Rowan J, Florkowski C . Is There a Role for HbA1c in Pregnancy?. Curr Diab Rep. 2016; 16(1):5. DOI: 10.1007/s11892-015-0698-y. View

13.

Feldman A, Brown F . Management of Type 1 Diabetes in Pregnancy. Curr Diab Rep. 2016; 16(8):76. PMC: 4919374. DOI: 10.1007/s11892-016-0765-z. View

14.

OSullivan J, Gellis S, DANDROW R, TENNEY B . The potential diabetic and her treatment in pregnancy. Obstet Gynecol. 1966; 27(5):683-9. View

15.

Greenberg J . The relationship between maternal glycemia and perinatal outcome. Obstet Gynecol. 2011; 117(5):1230. DOI: 10.1097/AOG.0b013e3182176774. View

16.

Du M, Ma R, Lao T, Chen Z, Xiao H, Tian Y . Early third trimester maternal response to glucose challenge and pregnancy outcome in Chinese women-relationship between upper distribution level and recommended diagnostic criteria. Eur J Clin Nutr. 2015; 69(10):1133-9. DOI: 10.1038/ejcn.2014.293. View

17.

Sweeting A, Ross G, Hyett J, Molyneaux L, Tan K, Constantino M . Baseline HbA1c to Identify High-Risk Gestational Diabetes: Utility in Early vs Standard Gestational Diabetes. J Clin Endocrinol Metab. 2016; 102(1):150-156. DOI: 10.1210/jc.2016-2951. View

18.

Arbib N, Shmueli A, Salman L, Krispin E, Toledano Y, Hadar E . First trimester glycosylated hemoglobin as a predictor of gestational diabetes mellitus. Int J Gynaecol Obstet. 2019; 145(2):158-163. DOI: 10.1002/ijgo.12794. View

19.

Rosenstein M, Cheng Y, Snowden J, Nicholson J, Doss A, Caughey A . The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol. 2012; 206(4):309.e1-7. PMC: 3403365. DOI: 10.1016/j.ajog.2012.01.014. View

20.

Battarbee A, Venkatesh K, Aliaga S, Boggess K . The association of pregestational and gestational diabetes with severe neonatal morbidity and mortality. J Perinatol. 2019; 40(2):232-239. DOI: 10.1038/s41372-019-0516-5. View