Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes

Bi, Jianing; Ji, Cunwei; Wu, Yuntao; Wu, Mingyang; Liu, Yunyun; Song, Lulu; Khatiwada, Shikha Upadhyaya; Yang, Senbei; Li, Bing; Wang, Youjie; Wu, Li

doi:10.1210/clinem/dgaa127

Cited by 17 publications

(21 citation statements)

References 36 publications

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“…Therefore, we still need to develop a recommended pregnancy weight gain value for Chinese women. Other studies have confirmed that, in addition to FPG, increased postprandial blood glucose and glycosylated hemoglobin are significantly associated with macrosomia in pregnant women with GDM [ 27 – 29 ]. Maternal hyperglycemia may cause morphological changes in the placentas of pregnant women.…”

Section: Discussionmentioning

confidence: 95%

Establishment of a nomogram model to predict macrosomia in pregnant women with gestational diabetes mellitus

Zou

Zhang

Yin

et al. 2021

BMC Pregnancy Childbirth

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Aim To establish a nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus in China. Methods We retrospectively collected the medical records of 783 pregnant women with gestational diabetes who underwent prenatal examinations and delivered at the Affiliated Hospital of Qingdao University from October 2019 to October 2020. The pregnant women were randomly divided into two groups in a 4:1 ratio to generate and validate the model. The independent risk factors for macrosomia in pregnant women with gestational diabetes mellitus were analyzed by multivariate logistic regression, and the nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus was established and verified by R software. Results Logistic regression analysis showed that prepregnancy body mass index, weight gain during pregnancy, fasting plasma glucose, triglycerides, biparietal diameter and amniotic fluid index were independent risk factors for macrosomia (P < 0.05). The areas under the ROC curve for internal and external validation of the model were 0.813 (95 % confidence interval 0.754–0.862) and 0.903 (95 % confidence interval 0.588–0.967), respectively. The calibration curve was a straight line with a slope close to 1. Conclusions In this study, we constructed a nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus. The model has good discrimination and calibration abilities, which can help clinical healthcare staff accurately predict macrosomia in pregnant women with gestational diabetes mellitus.

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Section: Discussionmentioning

confidence: 95%

Establishment of a nomogram model to predict macrosomia in pregnant women with gestational diabetes mellitus

Zou

Zhang

Yin

et al. 2021

BMC Pregnancy Childbirth

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“…The opinion that HbA1c might be slightly lower in normal pregnancies than in normal nonpregnant women has been raised previously [ 11 ]. However, whether the pregnancy is related to HbA1c levels in nondiabetic women remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Status Is Associated with Lower Hemoglobin A1c among Nondiabetes Women in the United States from NHANES 2005–2016

Huo

et al. 2022

International Journal of Endocrinology

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Background. It has been verified that the incidence rate of diabetes mellitus (DM) is sharply increased in pregnant female adults. However, the relationship between pregnant status and hemoglobin A1c (HbA1c) in nondiabetes women remains unclear. Methods. We conducted a cross-sectional study of 7762 participants in the National Health and Nutrition Examination Survey (NHANES) 2005–2016. Multivariable linear regression models were performed to evaluate the associations between pregnant status with HbA1c and serum glucose in nondiabetes women. Results. HbA1c was significantly lower in the pregnant group than in the nonpregnant group. There was a negative association between urine pregnancy test and HbA1c in all three models (model 1: β = −0.23, 95% CI: (−0.18 to −0.27); model 2: β = −0.20, 95% CI: (−0.15 to −0.24); model 3: β = −0.24, 95% CI: (−0.20 to −0.29)). In the subgroup analysis stratified by age, this negative association existed in all age subgroups (age <20: β = −0.20, 95% CI: (−0.04 to −0.27); age ≥20, <35: β = −0.24, 95% CI: (−0.20 to −0.29); age ≥35: β = −0.28, 95% CI: (−0.17, −0.39)). In the subgroup analysis stratified by race, the negative associations steadily existed in different subgroups (Mexican American:β = −0.20, 95% CI:(-0.11 to -0.29); Other Hispanic:β = -0.31, 95% CI: (-0.16 to -0.46); Non-Hispanic White: β = −0.24, 95% CI: (−0.17 to −0.31); Non-Hispanic Black: β = −0.21, 95% CI: (−0.12 to −0.31); Other races:β = −0.22, 95% CI: (−0.08 to −0.35)). On the other hand, a negative association between self-reported pregnant status and HbA1c was also found (model 1: β = −0.22, 95% CI: (−0.18 to −0.27); model 2: β = −0.19, 95% CI: (−0.15 to −0.2); model 3: β = −0.23, 95% CI: (−0.19 to −0.28)). In the subgroup analysis stratified by age, this negative association also existed in all age subgroups. Conclusions. The study indicated that nondiabetes women with pregnant status had significantly lower HbA1c compared with those nonpregnant. Moreover, the negative associations between pregnant status and HbA1c steadily existed in subgroups stratified by age and gender.

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“…Previous studies have varied widely in the selection of variables for adjustment. 7 , 17 Given this uncertainty, we explored univariate and multivariate associations between HbA1c and a number of possible confounders, chosen for their plausible association with HbA1c and their known association with pregnancy outcomes. We saw few associations in our data; just three factors met criteria for confounding: maternal age, BMI and sustained smoking at time of recruitment ( Supplementary Table S1 and Supplementary Figure S1 , available as Supplementary data at IJE online).…”

Section: Methodsmentioning

confidence: 99%

“…Until very recently, there has been little epidemiological research to explore this possibility. 2 , 17 Only a handful of epidemiological studies have studied HbA1c in pregnancy in women without diabetes. 7 , 16–21 …”

Section: Introductionmentioning

confidence: 99%

Glycated haemoglobin (HbA1c) in mid-pregnancy and perinatal outcomes

Carlsen

Harmon

Magnus

et al. 2022

International Journal of Epidemiology

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Background Maternal diabetes is a well-known risk factor for pregnancy complications. Possible links between long-term maternal blood sugar in the normal range and pregnancy complications are less well described. Methods We assayed glycated haemoglobin (HbA1c) in blood samples collected around the 18th week of pregnancy for 2937 singleton pregnancies in the Norwegian Mother, Father and Child Cohort Study (2000–09). Perinatal outcomes (gestational length, birthweight, birth length and head circumference, large-for-gestational age, small-for-gestational age, congenital malformations, preterm delivery and preeclampsia) were obtained from medical records. We tested associations using linear and log-binomial regression, adjusting for maternal age, body mass index (BMI) and smoking. Results Size at birth increased modestly but linearly with HbA1c. Birthweight rose 0.10 standard deviations [95% confidence interval (CI): 0.03, 0.16], for each 5-mmol/mol unit increase in HbA1c, corresponding to about 40 g at 40 weeks of gestation. Large-for-gestational age rose 23% (95% CI: 1%, 50%) per five-unit increase. Other pregnancy complications increased in non-linear fashion, with strongest associations within the top quartile of HbA1c (>35 mmol/mol or >5.4%). Per unit HbA1c within the top quartile, preterm delivery increased by 14% (95% CI: 1%, 31%), preeclampsia increased by 20% (95% CI: 5%, 37%) and gestational duration decreased by 0.7 days (95% CI: −1.0, −0.3). Conclusions Among women with no recorded diabetes, higher HbA1c levels at 18 gestational weeks were associated with important perinatal outcomes independent of mother’s age, smoking or BMI.

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Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes

Cited by 17 publications

References 36 publications

Establishment of a nomogram model to predict macrosomia in pregnant women with gestational diabetes mellitus

Establishment of a nomogram model to predict macrosomia in pregnant women with gestational diabetes mellitus

Pregnancy Status Is Associated with Lower Hemoglobin A1c among Nondiabetes Women in the United States from NHANES 2005–2016

Glycated haemoglobin (HbA1c) in mid-pregnancy and perinatal outcomes

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