165 Elevated hemoglobin A1c and postpartum weight retention

Abstract

To determine the association of an elevated Hemoglobin A1c (HbA1c) at start of pregnancy and postpartum (PP) weight retention in the absence of a diagnosis of diabetes. This is a retrospective cohort study of women undergoing universal HbA1c screening with initial prenatal labs (≤16 weeks) over a 2-year period (2016-2018) at a single tertiary care center. All women who delivered ≥32 weeks with documented weights at first prenatal visit, delivery, and PP visit were included. Women with preexisting or gestational diabetes, multiple gestation, or no glucose tolerance screening were excluded. Body mass index (BMI) was calculated and gestational weight gain assessed by IOM guidelines. The primary outcome was PP weight retention among women with normal versus elevated HbA1c. 889 women met inclusion criteria, of whom 753 (84.7%) had normal HbA1c and 136 (15.2%) had elevated HgbA1c. Overall, 19 (2.1%) were underweight, 406 (45.7%) normal weight, 207 (23.3%) overweight, and 257 (28.9%) obese at start of pregnancy. Compared to women with normal HbA1c, women with elevated HbA1c were more likely Black, multiparous, obese, and publicly insured (Table 1). Women with an elevated HbA1c gained less weight during pregnancy. Both groups had excessive weight gain. Women with an elevated HbA1c had significantly less PP weight retention (4.5kg vs. 3.1kg, p=0.003). More women in the elevated HbA1c group returned to their pre-pregnancy weight or less by the PP visit (Table 2). When comparing the groups by IOM guidelines, there were no differences in PP weight retention among women who met or exceeded the recommended weight. After adjusting for race, parity, insurance status and pre-pregnancy BMI, the association between elevated HbA1c and PP weight retention was no longer significant (aOR=-1.74 95% CI=-2.9, -0.4). In nondiabetic women, elevated HbA1c in early pregnancy is not associated with PP weight retention, after controlling for confounders. Further efforts to educate these women regarding weight gain during pregnancy and PP weight loss is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)