290: Association of early pregnancy hemoglobin A1c with placental lesions in diabetic pregnancy

Abstract

290 Association of early pregnancy hemoglobin 1c with placental lesions in diabetic pregnancy Roman Starikov, Vrishali Lopes, Kyle Inman, Dwight Rouse, renna Anderson, Kenneth Chen, Mai He Women & Infants Hospital of RI and the Warren Alpert Medical School of rown University, Obstetrics and Gynecology, Division of Maternal Fetal edicine, Providence, RI, Women & Infants Hospital of RI and the Warren Alpert Medical School of Brown University, Department of Research, Providence, RI, Women & Infants Hospital of RI and the Warren Alpert edical School of Brown University, Department of Medicine, Providence, I, Women & Infants Hospital of RI and the Warren Alpert Medical School of Brown University, Department of Pathology, Providence, RI OBJECTIVE: To examine the association between hemoglobin A1c HbA1c) levels measured during early pregnancy and histopathologcal lesions in the placentas of women with pregestational diabetes ellitus. STUDY DESIGN: Retrospective cohort study conducted from 2003 to 011 at a large tertiary care center. Women included had a singleton estation, pregestational diabetes mellitus, and information about deivery and placental pathology available for review. To quantify plaental lesions, the Index of Placental Changes (IPC) was calculated: PC Total Score 100/(37 n). “Total score” is the total number f lesions identified for a group of patients, 37 is the potential number f distinct lesions (Table), and “n” is the number of placentas examned. The IPC was compared across three groups of patients with iffering HbA1c levels ( 6.5%, 6.5-8.4%, and 8.5%). A linear reression plot was created with HbA1c as the continuous variable and PC as the primary outcome. We controlled for the following conounding variables: mean fasting and two-hour post-prandial glucose alues throughout pregnancy, and type of diabetes (1 vs. 2). RESULTS: 293 placentas were examined. HbA1c was measured at a ean of 9.5 wks’ gestation. 39.9% of women had type 1 and 60.1% had ype 2 diabetes. Median HbA1c was 7.5%(interquartile range 6.5%.9%). 23% of the cohort had HbA1c 6.5%, 41.9% had HbA1c of .5%-8.4%, and 34.8% had HbA1c 8.5%. BMI varied significantly by roup (35.4 vs. 34.4 vs. 32. from lowest to highest, respectively, P 0.04), ut maternal age, gravidity, parity, or race did not. There was no assocition of the IPC with HbA1c whether assessed categorically (10.5 vs. 10.1 s.10.4, respectively, P 0.7) or continuously, P 0.85. CONCLUSION: HbA1c value in early pregnancy does not predict the frequency of placental histopathological lesions among diabetic gravidas.