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

Abstract

AimsThe aim of this study is to determine the association of elevated HbA1c in the first trimester (HbA1c-FT) with adverse events among pregnant Asian Indian women without gestational diabetes (GDM). MethodsThis retrospective cohort study included 1618 pregnant women who delivered at a single urban tertiary care center and had HbA1c-FT estimation between January 2011 and September 2017. Those with GDM according to a 75-g OGTT after 24 gestational weeks were excluded. Multivariable logistic regression models assessed the association between elevated HbA1c-FT and adverse events. ResultsAt a cutoff of ≥37 mmol/mol (5.5%), HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10, 95% CI 1.11–3.98). There was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol (0.5%) increase in HbA1c-FT for primary caesarean delivery: 1.27, 95% CI 1.06–1.52). In the crude analysis, gestational hypertension was associated with HbA1c-FT, but not after adjustment for confounding factors. HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications). ConclusionsEven without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women.