Utility of the third trimester haemolgobin A1c in predicting outcomes of diabetes in pregnancy — ASN Events
  1. Schedule
  2. Session 3: Antenatal and Technology
  3. Utility of the third trimester haemolgobin A1c in predicting outcomes of diabetes in pregnancy

Utility of the third trimester haemolgobin A1c in predicting outcomes of diabetes in pregnancy (#14)

Lili Yuen 1 2 , Alan Phan 3 , Aishah Virk 3 , Rhea Gu 3 , Jincy Varghese 4 , David Simmons 4
  1. School of Medicine and the Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
  2. Central Coast Local Health District, Gosford, NSW, Australia
  3. School of Medicine, Western Sydney University, Penrith, NSW, Australia
  4. Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia

Aim:

Glycaemic control in the third trimester in patients with gestational diabetes is an important determinant of obstetric and neonatal outcomes. It is unknown whether the haemoglobin A1c level (HbA1c) is a good predictor of outcomes in the third trimester.

 

Method:

We retrospectively examined the HbA1c collected in the third trimester in a retrospective multi ethnic cohort of women who delivered at Campbelltown Hospital between 2015 to 2019.  HbA1c were stratified to LOW or normoglycaemia (<5.7%)(1), MID (5.7 to 6.39%) and HIGH (≥6.4%) to determine whether the groups were indicative of improved obstetric and neonatal outcomes.

 

Results:

For 1672 women who had HbA1c collected during the third trimester, the mean was 5.44% (SD ±1.85), with 1303 “LOW”, 335 “MID” and 34 “HIGH” cases.  HbA1c were associated with a significantly higher pre-pregnancy weight (77.9±22.6kg versus 84.9±22.4kg versus 100.0±21.9kg) and BMI compared to the other HbA1c groups (29.2±7.6 versus 31.8±7.2 versus 37.1±8.3).  HbA1c was associated with higher use of metformin (5% versus 9% versus 21%) and insulin (49.3% versus 61.7% versus 91.3%).  HbA1c groups were also associated with more hypertensive disorders (14.2% versus 22.4% versus 31.3%) but not pre-eclampsia. The mean baby weight was higher according to HbA1c but not statistically different (3310±569g versus 3321±542g versus 3402±720g).  There were no increases within HbA1c groups for other neonatal outcomes such as hypoglycaemia, jaundice, use of oxygen therapy, congenital abnormalities, or death.

 

Conclusion:

HbA1c collected in the third trimester was positively associated with hypertensive disorders, higher use of insulin and metformin therapies and pre-pregnancy weight but not predictive of other birth outcomes in women with hyperglycaemia in pregnancy.

 

References:

 

  1. O’Connor C, O’Shea PM, Owens LA, Carmody L, Avalos G, Nestor L, et al. Trimester-specific reference intervals for haemoglobin A1c (HbA1c) in pregnancy. Clin Chem Lab Med. 2011 Nov 26;50(5):905–9.

 

 

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