1183: YouTube as a source of patient information regarding placenta accreta spectrum

Abstract

OBJECTIVE: To determine the relationship of Hemoglobin A1c (HbA1c) on universal screening to gestational diabetes (GDM) development. STUDY DESIGN: This is a retrospective cohort study of women undergoing universal HbA1c screening at first prenatal visit < 17 weeks' gestation between December 2016 and April 2018 at a single urban tertiary care center. Women with preexisting diabetes, multiple gestation, hemoglobinopathy, fetal demise, and no glucose tolerance screening were excluded. Women with HbA1c values < 5.7% did routine two-step GDM screening. Women with HbA1c of 5.7-6.4% were asked to do two-step GDM screening upon receipt of their HbA1c results. Positive screens were diagnosed with early GDM. Women with normal early screening underwent repeat screening in the third trimester. The primary outcome was development of GDM. The association between HbA1c and GDM was modeled using logistic regression with HbA1c as both a continuous predictor and dichotomized at the cutoff of 5.7%. RESULTS: 3072 women underwent universal HbA1c screening, and 1921 women met inclusion criteria. There were 237(12.3%) women with an elevated HbA1c. Women with elevated HbA1c were more likely to be older, Black, and obese compared with women with normal HbA1c values (Table 1). Of women with elevated HbA1c, 212(73.9%) women completed early screening, and 21/237(8.9%) were diagnosed with early GDM (Fig 1). 47(19.8%) of women with elevated HbA1c were diagnosed with GDM compared to 85(5.1%) of women with normal HbA1c (p < 0.001). There was no difference in need for insulin in women with GDM based on HbA1c. After adjusting for race, BMI, age, and insurance, the odds of GDM development are 3.50 (95%CI 2.27-5.40) times higher among women with HbA1c 5.7% compared to those with a normal HbA1c. The adjusted odds of GDM increase by 8.27 (95%CI 4.39-15.59) for every 0.1 unit increase in HbA1c. CONCLUSION: An elevated HbA1c on universal screening is associated with an increased risk of GDM. Independent of confounders, the odds of GDM increase by 8-fold for every 0.1 unit increase in HbA1c.