Abstract
To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.
Highlights
The worldwide prevalence of gestational diabetes mellitus (GDM) has increased [1] and it is nowadays the commonest endocrine pregnancy complication.In 2008, the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was the first large-scale multinational study to show that maternal hyperglycemia between 24-28 weeks was linearly and positively correlated with large-for-gestationalage (LGA) infants, caesarian rate, cord-blood serum C-peptide level, and neonatal hypoglycemia
It is a known fact that poorly controlled GDM, pre-pregnancy obesity and excessive weight gain during pregnancy increase the risk of LGA and several other neonatal complications [2,11,19,20,21]
In this study, pregnant women with characteristics that favored the development of insulin resistance, such as prepregnancy obesity, higher weight gain and need for insulin therapy, were associated with a higher risk of having LGA newborns
Summary
The worldwide prevalence of gestational diabetes mellitus (GDM) has increased [1] and it is nowadays the commonest endocrine pregnancy complication.In 2008, the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was the first large-scale multinational study to show that maternal hyperglycemia between 24-28 weeks was linearly and positively correlated with large-for-gestationalage (LGA) infants, caesarian rate, cord-blood serum C-peptide level, and neonatal hypoglycemia. GDM is associated with several adverse maternal and fetal outcomes; one of the most. Third trimester HbA1c and LGA neonates worrying is the increased risk for macrosomia and later obesity in the offspring [2,3,4,5,6]. Pregnancies complicated by GDM result in maternal and fetal hyperglycemia. Hyperinsulinemia and glucose excess in utero cause insulin-sensitive tissue hypertrophy, promoting accelerated growth that can lead to macrosomia and/ or large-for-gestational-age (LGA) neonates [1,4,7,8]. GDM severity during pregnancy has been clearly linked with fetal overgrowth [2,5,6,9,10,11], while HbA1c improvement has been associated with a lower risk of LGA [12]. Given the potentially serious consequences for the mother and the child, there is significant interest in predicting the occurrence of LGA, and its accurate identification holds potential for guiding appropriate management and intervention
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