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Despite treatment, HbA1c ≥ 37 mmol/mol in the first trimester is associated with premature delivery among South Asian women with gestational diabetes mellitus: a retrospective cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To examine the effects of first-trimester HbA1c (HbA1c-FT) ≥ 37 mmol/mol on preterm birth (PTB) and large-for-gestational-age (LGA) babies in a retrospective cohort of South Asian pregnant women with gestational diabetes (GDM).

Methods

The cohort (n = 686) was separated into two groups based on HbA1c-FT values: Group A (n = 97) and Group B (n = 589), with values of 37–46 mmol/mol (5.5–6.4%) and < 37 mmol/mol (5.5%), respectively. HbA1c-FT's independent influence on PTB and LGA babies was examined using multivariable logistic regression in groups A and B women. The reference group (Group C) included 2031 non-GDM women with HbA1c-FT < 37 mmol/mol (< 5.5%). The effects of HbA1c-FT on PTB and LGA babies in obese women in Groups A, B, and C (designated as A-ob, B-ob, and C-ob, respectively) were re-analyzed using multivariable logistic regression.

Results

Group A GDM women with greater HbA1c-FT had a higher risk for PTB (aOR:1.86, 95% CI:1.10–3.14) but not LGA babies (aOR:1.13, 95%: 0.70–1.83). The risk of PTB was higher for obese women in Group A-ob: aOR 3.28 [95% CI 1.68–6.39]. However, GDM women with normal HbA1c-FT exhibited no elevated risk for PTB: Groups B and B-ob had aORs of 1.30 (95% CI 0.86–1.98) and 1.28 (95% CI 0.88–1.85) respectively.

Conclusions

South Asian GDM women with prediabetic HbA1c FT; 37–46 mmol/mol (5.5–6.4%) are more likely to deliver preterm babies despite treatment, while the risk for LGA babies was the same as non-GDM women.

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Data availability

Data of this study is available on reasonable request to the corresponding author.

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Acknowledgements

We have not received any funding or grant from any organization for the conduct of this study.

We gratefully acknowledge the immense help received from Sheeba Samuel, Sapna Robinson (diabetes nurses) and Aashish Kumar, Nikita Tyali, Deepali Garg (diabetes educators) of Dept of Endocrinology, St. Stephen’s Hospital in the collection of data for this study.

Funding

There is no funding for this research work.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Tis Hazari, Delhi, 110054, India

    John Punnose, Komal Sukhija & Rashika M. Rijhwani

  2. Dr BRA IRCH, AIIMS, Delhi, India

    Rajeev Kumar Malhotra

  3. Department of Obstetrics and Gynecology, St. Stephen’s Hospital, Delhi, India

    Naimaa Choudhary & Asha Sharma

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  1. John Punnose
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  4. Rashika M. Rijhwani
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  5. Naimaa Choudhary
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  6. Asha Sharma
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Contributions

J. Punnose: Project Development, Study Design, Data Management, and Manuscript Writing. R. Malhotra: Study Design, Data Analysis, and Manuscript Writing and Editing. K. Sukhija: Study Design, Manuscript Editing. RM Rijhwani: Study Design, Manuscript Editing. N. Choudhary: Study Design, Data Collection, and Manuscript Editing. A Sharma: Study Design, Data Collection, and Manuscript Editing.

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Correspondence to John Punnose.

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Punnose, J., Malhotra, R.K., Sukhija, K. et al. Despite treatment, HbA1c ≥ 37 mmol/mol in the first trimester is associated with premature delivery among South Asian women with gestational diabetes mellitus: a retrospective cohort study. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07422-4

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