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Aim: To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis.Methods: This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM-No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable.Results: Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed.Conclusions: Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.

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Objectives: This study aimed to define trimester-specific hemoglobin A1c (A1c) reference intervals among healthy South Asian pregnant women. Methods: In this restrospective study,1357 pregnant women without diabetes, gestational diabetes, gestational hypertension, anemia, β-thalassemia, or systemic diseases were included. They had term delivery of babies having weight appropriate for gestational age. A1c (using high performance liquid chromatography, meeting the National Glycohemoglobin Standardization Program and International Federation of Clinical Chemistry standards), hemoglobin, and RBC indices were estimated at the first antenatal visit. The A1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2), and third (T3) trimester groups. The control group included 67 healthy non-pregnant women. Statistical tests were used to obtain the normal the normal reference values for the HbA1c . and the tests were considered significant when p value <0.05. Results: The median HbA1c (2.5 to 97.5 percentiles) was lower among the pregnant women; 4.8 (4-5.5) % or 32 (20-39) mmol/mol than in the non pregnant women; 5.1 (4-5.7) % or 29 (20-37) mmol/mol ( p <0.001). These were 4.9 (4.1-5.5) % or 30 (21-37) mmol/mol, 4.8 (4-5.3) % or 29 (20-34) mmol/mol, and 4.8 (3.9-5.6) % or 29 (19-38) mmol/mol for the T1, T2 and T3 groups, respectively; p-values:T1 vs T2=<0.001, T1 vs T3= 0.002, T2 vs T3= 0.111, T1 vs non pregnant group = <0.001. Conclusions: Compared to normal non pregnant women, the A1c was lower in normal pregnant women in South Asian population. These A1c changes were observed despite having significantly higher body max index among women in the T2 and T3 groups than in the T1 and non pregnant groups. To understand the factors determining the A1c decrease in pregnancy and to validate the findings of this study, we recommend further prospective studies among South Asian womenKeywords: Asian, Gestational diabetes, HbA1c , Pregnancy trimesters, Reference  values.