421: Perinatal outcomes in a contemporary cohort of pregestational diabetic women with hemoglobin A1c values >10%

Abstract

Because hemoglobin A1c (HbgA1c) values greater than 10% in the first trimester have been associated with increased rates of fetal anomalies in women with pregestational diabetes mellitus (DM), our aim was to examine perinatal outcomes according to HbgA1c values greater than 10% in the first trimester. This was a retrospective cohort study of pregnant women with pregestational DM at a single academic center. All women included in this analysis had a HbgA1c value obtained at presentation to prenatal care at less than 14 weeks gestation and delivered at our hospital. Maternal characteristics and perinatal outcomes were compared between women with HbgA1c values of ≤10% and those with HbgA1c values of >10%, and for specific perinatal outcomes an analysis across rising HbgA1c values was performed. Between May 2009 and December 2018, a total of 1,052 women met inclusion criteria. Of these, 273 (26%) had a first trimester HbgA1c of greater than 10%. When compared to women with HbgA1c < 10%, women with HbgA1c >10% were older (30+6 vs 32+6 years, P< 0.001) and had a longer duration of DM—6[3,10] vs 4 [2,7] years (P< 0.001). Selected perinatal outcomes are shown in the Table. Women with HbgA1c values >10% had significantly higher rates of preeclampsia (P=0.002), shoulder dystocia (P=0.045), neonatal death (P=0.042), and fetal anomalies (P< 0.001). As shown in the Figure, HbgA1c values above 10% were significantly associated with increased rates of preeclampsia—OR 1.16 (1.08, 1.23). Reflecting limited access to care outside of pregnancy, more than one-quarter of women with DM entered prenatal care with a HbgA1c of >10%. Such HbgA1c values >10% in early pregnancy were associated with increased rates of adverse perinatal outcomes to include preeclampsia, fetal anomalies, and neonatal death when compared to those with HbgA1c < 10%. Indeed, there appears to be a significant relationship between elevated HbgA1c values above 10% and increased rates of preeclampsia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)