Pregnancy outcomes in women with booking HbA1c ≤ 40 mmol/mol compared with 41-49 mmol/mol in South Auckland, New Zealand.
diabetes
gestational
glucose tolerance
glycosylated
hemoglobin A
pregnancy outcome
prenatal care
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
19
02
2021
received:
05
10
2020
accepted:
22
03
2021
pubmed:
14
5
2021
medline:
3
11
2021
entrez:
13
5
2021
Statut:
ppublish
Résumé
There are few data on pregnancy outcomes in women with pre-diabetes (HbA1c 41-49 mmol/mmol) at pregnancy booking. We aimed to (i) identify the proportion of women in Counties Manukau Health (CMH), South Auckland, New Zealand (NZ), with pre-diabetes at booking and (ii) compare outcomes between women with normal HbA1c and pre-diabetes. Using data from a multi-ethnic population of 10,869 singleton pregnancies, booked at <20 weeks from January 2017 to December 2018 in CMH, we compared outcomes between those with normal HbA1c (≤40 mmol/mol) and those with pre-diabetes (HbA1c 41-49 mmol/mol). The primary outcomes were gestational diabetes mellitus (GDM) by NZ criteria and large for gestational age (LGA) defined as birthweight >90th customised centile. Logistic regression determined the contribution of HbA1c 41-49 mmol/mol to the development of GDM. Among 10,869 participants, 193 (1.78%) had an HbA1c 41-49 mmol/mol at <20 weeks' gestation. Those with HbA1c 41-49 mmol/mol were 11 times more likely to develop GDM (59.6 vs 7.9%; adjusted odds ratio (aOR) 11.16 (7.59, 16.41)) and were more likely to have an LGA baby (47 (24.4%) vs 1436 (13.5%) aOR 1.63 (1.10, 2.41)) versus those with normal HbA1c. They also had significantly higher rates of pre-eclampsia, caesarean sections, preterm births and perinatal deaths. Nearly two-thirds of women with a booking HbA1c of 41-49 mmol/mmol developed GDM as well as multiple other perinatal complications compared to women with HbA1c ≤40. Trials to evaluate the impact of treatment in early pregnancy on the risk of late-pregnancy complications are required.
Substances chimiques
Glycated Hemoglobin A
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
742-749Informations de copyright
© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
Ekeroma AJ, Chandran GS, McCowan L et al. Impact of using the international association of diabetes and pregnancy study groups criteria in South Auckland: prevalence, interventions and outcomes. Aust NZ J Obstet Gynaecol 2015; 55: 34-41.
Metzger BE, Contreras M, Sacks DA et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358(19): 1991-2002.
Noctor E, Dunne FP. Type 2 diabetes after gestational diabetes: the influence of changing diagnostic criteria. World J Diabetes 2015; 6: 234-244.
Crowther CA, Hiller JE, Moss JR et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005; 352(24): 2477-2486.
Landon MB, Spong CY, Thom E et al. Randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009; 361(14): 1339-1348.
New Zealand Ministry of Health. Screening, Diagnosis and Management of Gestational Diabetes in New Zealand; A clinical Practice Guideline, 2014. Available from URL: https://www.health.govt.nz/system/files/documents/publications/screening-diagnosis-management-of-gestational-diabetes-in-nz-clinical-practive-guideline-dec14-v2.pdf
Immanuel J, Simmons D. Screening and treatment for early-onset gestational diabetes mellitus: a systematic review and meta-analysis. Curr Diab Rep 2017; 17: 115.
Hughes RCE, Moore MP, Gullam JE et al. An early pregnancy HbA1c ≥5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care 2014; 37(11): 2953-2959.
Arbib N, Shmueli A, Salman L et al. First trimester glycosylated hemoglobin as a predictor of gestational diabetes mellitus. Int J Gynecol Obstet 2019; 145(2): 158-163.
Chen LU, Pocobelli G, Yu O et al. early pregnancy hemoglobin A1C and pregnancy outcomes: a population-based study. Am J Perinatol 2019; 36(10): 1045-1053.
Mañé L, Flores-Le Roux JA, Benaiges D et al. Role of first trimester HbA1c as a predictor of adverse obstetric outcomes in a multi-ethnic cohort. J Clin Endocrinol Metab 2016; 102(2): 2016-2581.
National Women’s Health. Annual Clinical Report 2018. New Zealand: Auckland District Health Board, 2018. Available from URL: http://www.adhb.health.nz/assets/Uploads/ADHB-Annual-Report-2017-18-FINAL.pdf
New Zealand Counties Manukau Health. Screening and Diagnostic Criteria for Diabetes in Pregnancy (DIP) Guideline 2015. Available from URL: Intranet of Counties Manukau Health.
Ministry of Health of New Zealand (Manatu Hauora). Population of Counties Manukau DHB 2015/2016. Available from URL: https://countiesmanukau.health.nz//assets/About-CMH/Reports-and-planning/Womens-health/0b4be0966d/2015-2016-CM-Health-MQSP-Annual-Report.pdf
Anderson NH, Sadler LC, Stewart AW, McCowan LME. Maternal and pathological pregnancy characteristics in customised birthweight centiles and identification of at-risk small-for-gestational-age infants: a retrospective cohort study. BJOG 2012; 119(7): 848-856.
Duley L, Meher S, Hunter KE et al. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2019; 10: CD004659.
Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Syst Rev 2018; 10: CD001059.
Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115(3): e290-e296.
Fong A, Serra AE, Gabby L et al. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. Am J Obstet Gynecol 2014; 211(6): 641.e1-641.e7
Hinkle SN, Tsai MY, Rawal S et al. HbA1c measured in the first trimester of pregnancy and the association with gestational diabetes. Sci Rep 2018; 8: 12249.
Mañé L, Flores-Le Roux JA, Benaiges D et al. Role of first-trimester HbA1c as a predictor of adverse obstetric outcomes in a multiethnic cohort. J Clin Endocrinol Metabol 2017; 102(2): 390-397.
Roberts AB, Baker JR, Metcalf P, Mullard C. Fructosamine compared with a glucose load as a screening test for gestational diabetes. Obstet Gynecol 1990; 76(5 Pt 1): 773-775.
HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes 2009; 58(2): 453-459.
Rowan JA, Budden A, Sadler LC. Women with a nondiagnostic 75 g glucose tolerance test but elevated HbA1c in pregnancy: an additional group of women with gestational diabetes. Aust NZ J Obstet Gynaecol 2014; 54(2): 177-180.
Hughes RCE, Rowan J, Williman J. Prediabetes in pregnancy, can early intervention improve outcomes? A feasibility study for a parallel randomised clinical trial. BMJ Open 2018; 8(3): e018493.