Is HbA1c in the first trimester associated with adverse outcomes among pregnant Asian Indian women without gestational diabetes?

Punnose, John; Malhotra, Rajeev; Sukhija, Komal; Rijhwani, Rashika M.; Choudhary, Naimaa; Sharma, Asha; Vij, Prassan; Bahl, Pinky

doi:10.1016/j.jdiacomp.2022.108187

Cited by 13 publications

(22 citation statements)

References 27 publications

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“…Furthermore, an independent association of HbA1c in the first trimester with adverse pregnancy events was reported by several researchers 17,18 . In an earlier study amongst Asian Indian pregnant women with normal OGTT at 24–28 Gw, we reported an association of HBA1c in the first trimester with preterm birth and primary caesarian delivery 19 . These studies suggest that adverse events triggered by ‘hyperglycemia in first trimester’ are not fully reversible, despite having euglycemia in later pregnancy.…”

Section: Discussionsupporting

confidence: 66%

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment

et al. 2022

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Aim: To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis.Methods: This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM-No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable.Results: Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed.Conclusions: Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.

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Section: Discussionsupporting

confidence: 66%

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment

et al. 2022

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“…Our findings are in accordance with the HAPO study that showed HbA1c ≥5.8% (at 24 -32 gestational weeks) was significantly associated with an increased risk of primary C- section compared to lower HbA1c levels in pregnant women with hyperglycemia ( 10 ). On the other hand, HbA1c in the early trimester at a mean gestational week of 9.25 was significantly associated with primary C-section in non-diabetic Indian women ( 40 ). Researchers hypothesize that abnormal glycemia in early pregnancy, which may be indicated by comparatively high HbA1c at the time of GDM diagnosis, is the mechanism underlying the relationship between primary C-section and higher mid-pregnancy HbA1c levels ( 40 ).…”

Section: Discussionmentioning

confidence: 97%

“…On the other hand, HbA1c in the early trimester at a mean gestational week of 9.25 was significantly associated with primary C-section in non-diabetic Indian women ( 40 ). Researchers hypothesize that abnormal glycemia in early pregnancy, which may be indicated by comparatively high HbA1c at the time of GDM diagnosis, is the mechanism underlying the relationship between primary C-section and higher mid-pregnancy HbA1c levels ( 40 ). HbA1c reflects glycemia status in the past several weeks; thus, relatively high HbA1c at the time of GDM diagnosis might be associated with poor glycemic control during early pregnancy.…”

Section: Discussionmentioning

confidence: 97%

The association between maternal HbA1c and adverse outcomes in gestational diabetes

Muhuza

Zhang

et al. 2023

Front. Endocrinol.

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BackgroundThe role of HbA1c in women with gestational diabetes mellitus (GDM) is still unclear, particularly in the Asian population.AimTo investigate the association between HbA1c levels and adverse outcomes considering maternal age, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) in women with GDM.MethodA retrospective study included 2048 women with GDM and singleton live births. Using logistic regression, the associations between HbA1c and adverse pregnancy outcomes were assessed.ResultCompared to women with HbA1c ≤ 5.0%, HbA1c was significantly associated with macrosomia (aOR 2.63,95%CI1.61,4.31), pregnancy-induced hypertension (PIH, aOR 2.56,95%CI1.57,4.19), preterm birth (aOR 1.64,95%CI 1.05,2.55), and primary Cesarean section (primary C-section, aOR1.49,95%CI1.09,2.03) in GDM women with HbA1c ≥5.5% while significantly associated with PIH (aOR 1.91,95%CI1.24,2.94) in women with HbA1c 5.1-5.4%. The associations between HbA1c and adverse outcomes varied with maternal age, pre-pregnancy BMI, and GWG. In women aged ≤29 years, there’s significant association between HbA1c and primary C-section when HbA1c was 5.1-5.4% and ≥5.5%. In women aged 29-34 years and HbA1c ≥5.5%, HbA1c was significantly associated with macrosomia. In women aged ≥35 years, there’s significant association between HbA1c and preterm birth when HbA1c was 5.1-5.4% and macrosomia and PIH when HbA1c ≥5.5%. In pre-pregnant normal-weight women, HbA1c was significantly associated with macrosomia, preterm birth, primary C-section, and PIH when HbA1c ≥5.5% while HbA1c was significantly associated with PIH when HbA1c was 5.1-5.4% . In pre-pregnant underweight women with HbA1c 5.1-5.4%, HbA1c was significantly associated with primary C-section. HbA1c was significantly associated with macrosomia among women with inadequate GWG or excess GWG and HbA1c≥5.5%. In women with adequate GWG, there’s significant association between HbA1c and PIH when HbA1c was 5.1-5.4% and ≥5.5% .ConclusionConclusively, HbA1c at the time of diagnosis is significantly associated with macrosomia, preterm birth, PIH, and primary C-section in Chinese women with GDM.

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“…Acquisition of data for 14 days would have required the serial insertion of multiple sensors (in a single subject), which was logistically challenging, as many women had normoglycemia. We did not perform a functional data analysis, as done by other authors [ 18 ]; however, considering that the clinical decisions are often taken in terms of CGMS parameters proposed by Hernandez et al, we evaluated them as per their standard format.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent evidence also suggests that women diagnosed with isolated FPG elevation (5.1-6.9 mmol/L) in early pregnancy have adverse pregnancy outcomes, despite a normal OGTT after 24 weeks of gestation [15][16][17]. Similarly, isolated HbA1c elevation during early pregnancy has been associated with adverse outcomes [18,19]. In our study, we evaluated and compared various meal-related parameters and 24-h mean glucose values between women with normoglycemia and those with a missed diagnosis of GDM using strategies alternative to WHO 2013 criteria and found clinically meaningful differences in various glycemia-related parameters.…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Continuous Glucose Monitoring System Profile of Women with Gestational Diabetes Mellitus Missed Using Isolated Fasting Plasma Glucose-Based Strategies Alternative to WHO 2013 Criteria: A Cross-Sectional Study

et al. 2022

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Introduction:The aim of the study was to evaluate the differences in the continuous glucose monitoring system (CGMS)-based glycemic parameters between women with normoglycemia and early gestational diabetes mellitus (GDM) identified on the basis of mild fasting plasma glucose elevation (FPG, 5.1-5.5 mmol/L) and/or post-load plasma glucose elevation (PLG, 1-h C 10.0 mmol/L or 2-h C 8.5 mmol/L). Methods: This cross-sectional study included women with singleton pregnancy (8 ?0 to

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Is HbA1c in the first trimester associated with adverse outcomes among pregnant Asian Indian women without gestational diabetes?

Cited by 13 publications

References 27 publications

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment

The association between maternal HbA1c and adverse outcomes in gestational diabetes

Continuous Glucose Monitoring System Profile of Women with Gestational Diabetes Mellitus Missed Using Isolated Fasting Plasma Glucose-Based Strategies Alternative to WHO 2013 Criteria: A Cross-Sectional Study

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