Abstract
Background
Pregestational diabetes mellitus (PGDM) confers an increased risk of adverse maternal
and neonatal outcomes [1,2]. Glycaemic control in the medium and long term is commonly
evaluated by examining glycosylated haemoglobin (HbA1c) levels. However, the value
of HbA1c in pregnancy may be diminished by increased level of red cell turnover characteristic
of pregnancy [
3
,
4
]. We sought to examine the impact of HbA1c in the first trimester and pre-delivery,
and the within-patient change throughout gestation on mode of delivery and birthweight
in pregnancies complicated by a pre-pregnancy diagnosis of type I or type II diabetes.Methods
A 10-year consecutive cohort of pregnancies complicated by PGDM, from Jan 2010 until
Dec 2019, was examined for HbA1c data in the first trimester and within 6 weeks of
delivery. Perinatal outcome data, including gestational age at delivery, mode of delivery
and birthweight centile, were obtained from hospital records. The Spearman Rank correlation
was used to correlate HcA1c levels in the first trimester with birthweight centiles.
Non-parametric summaries and rank-based tests, Signed-rank test and Kruskal-Wallis
test, were used to compare Hba1c levels.
Results
During the 10-year study period, a consecutive cohort of 396 pregnancies that attained
a viable gestational age (>24 weeks’ gestation) and complicated by pregestational
diabetes was identified; representing 81 % of the population of pregestational diabetic
pregnancies managed by this service during the study period. The median [IQR] HbA1c
levels (mmol/mol) in the first trimester, pre-delivery and the differential across
gestation were 51 [19] mmol/mol, 43 [11] mmol/mol and −8 [13] mmol/mol, respectively.
A statistically significant reduction in HbA1c levels throughout gestation was observed
(p < 0.001). The median [IQR] birthweight centile was 69 [50 – 96]. The distributions
in HbA1c levels and birthweight centiles were heavily skewed. No correlation was identified
between HbA1c levels and mode of delivery.
Conclusion
Neither baseline HbA1c levels, pre-delivery values, nor trends across gestation appear
to impact birthweight centile or mode of delivery in PGDM. While optimising glycaemic
control can affect the long term health of the mother, these indices cannot be relied
upon to reflect the impact of glycaemic control on fetal growth aberrations that influence
mode of delivery.
Abbreviations:
ACOG (American College of Obstetricians and Gynecologists), HbA1c (glycosylated haemoglobin), ICU (intensive care unit), IQR (interquartile range), NICE (National Institute for Health and Care Excellence), PGDM (pregestational diabetes mellitus), WHO (World Health Organization)Keywords
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Article info
Publication history
Published online: December 07, 2022
Accepted:
December 5,
2022
Received in revised form:
October 30,
2022
Received:
June 9,
2022
Identification
Copyright
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