Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes?
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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HbA1c ≤ 7.0% (49) | HbA1c > 7.0% (45) | p | |
---|---|---|---|
Maternal age at pregnancy (years) | 34.00 (31.00–36.00) | 32.00 (28.00–37.00) | 0.082 |
Weight gain during pregnancy (kg) | 13.15 (11.00–15.35) | 14.00 (10.80–15.85) | 0.499 |
Pre-gestational BMI (kg/m2) | 23.40 (22.00–26.00) | 24.00 (21.90–28.00) | 0.764 |
BMI at term of pregnancy (kg/m2) | 28.40 (26.50–31.00) | 30.00 (27.00–33.00) | 0.324 |
Spontaneous miscarriages | 0.00 (0.00–1.00) | 0.00 (0.00–0.00) | <0.05 |
Primigravidas | 32.65% (16/49) | 46.67% (21/45) | 0.165 |
Race | |||
Caucasian | 89.80% (44/49) | 93.33% (42/45) | 0.539 |
North-African | 6.12% (3/49) | 4.44% (2/45) | 0.717 |
Sub-Saharan African | 4.08% (2/49) | 2.22% (1/45) | 0.608 |
Conception mode | |||
IVF/ET | 2.04% (1/49) | 0.00% (0/45) | 0.335 |
IUI | 2.04% (1/49) | 0.00% (0/45) | 0.335 |
Spontaneous | 95.92% (47/49) | 100.00% (45/45) | 0.171 |
Number of ultrasound examinations during pregnancy | 6.50 (4.00–8.25) | 8.00 (7.00–10.00) | 0.063 |
HbA1c ≤ 7% (49) | HbA1c > 7% (45) | p | |
---|---|---|---|
Maternal age at DM diagnosis (years) | 26.00 (18.00–32.00) | 20.00 (12.50–27.00) | <0.05 |
HBA1c (%) at term of pregnancy | 5.8 (5.7–6.0) | 6.7 (6.3–7.3) | <0.05 |
Daily insulin units (at start of pregnancy) | 30.00 (17.50–39.00) | 38.00 (24.00–44.00) | 0.059 |
Daily insulin units (at term of pregnancy) | 47.92 (39.00–67.30) | 64.00 (48.00–82.00) | <0.05 |
Pre-gestational diabetes type | |||
Type 1 | 75.51% (37/49) | 82.22% (37/45) | 0.427 |
Type 2 | 24.49% (12/49) | 17.78% (8/45) | 0.427 |
Diabetes therapy before pregnancy | |||
Diet/no therapy | 18.37% (9/49) | 11.11% (5/45) | 0.324 |
Metformin | 6.12% (3/49) | 6.67% (3/45) | 0.914 |
Multi-injective Insulin | 51.02% (25/49) | 60.00% (27/45) | 0.382 |
Pump | 24.49% (12/49) | 22.22% (10/45) | 0.795 |
Previous GDM | 12.24% (6/49) | 6.67% (3/45) | 0.359 |
First degree familiarity for diabetes | 85.71% (42/49) | 80.00% (36/45) | 0.461 |
Microalbuminuria | 2.04% (1/49) | 8.89% (4/45) | 0.139 |
Proteinuria | 4.08% (2/49) | 20.00% (9/45) | <0.05 |
Hypothyroidism | 20.41% (10/49) | 20.00% (9/45) | 0.961 |
HbA1c ≤7% (49) | HbA1c >7% (45) | p | |
---|---|---|---|
Gestational age at delivery (weeks) | 38.14 (38.00–38.43) | 37.57 (35.57–38.00) | <0.05 |
Neonatal weight (gr) | 3484.00 (3140.00–3710.00) | 3357.50 (3048.00–3832.00) | 0.882 |
Placental weight (gr) | 652.00 (552.50–777.50) | 570.00 (500.00–650.00) | 0.145 |
SGA < 10° percentile | 0.00% (0/45) | 2.38% (1/42) (**) | 0.298 |
LGA > 90° percentile | 35.56% (16/45) | 47.62% (20/42) | 0.254 |
LGA > 97° percentile | 24.44% (11/45) | 40.48% (17/42) | 0.110 |
Delivery mode | |||
Vaginal delivery | 28.57% (14/49) | 20.00% (9/45) | 0.334 |
Vaginal operative delivery | 16.33% (8/49) | 17.78% (8/45) | 0.852 |
Cesarean delivery | 55.10% (27/49) | 62.22% (28/45) | 0.484 |
Indications for cesarean delivery | |||
Previous cesarean delivery | 40.74% (11/27) | 21.43% (6/28) | 0.121 |
Suspected birth asphyxia | 22.22% (6/27) | 28.57% (8/28) | 0.589 |
Maternal indications | 11.11% (3/27) | 17.86% (5/28) | 0.478 |
Labor dystocia (mechanical or dynamic) | 11.11% (3/27) | 21.43% (6/28) | 0.301 |
Fetal malpresentation | 11.11% (3/27) | 3.57% (1/28) | 0.282 |
Abnormal fetal growth/other | 3.70% (1/27) | 7.14% (2/28) | 0.574 |
Composite pregnancy negative outcome (*) | 40.82% (20/49) | 71.11% (32/45) | <0.05 |
Hypertensive disorders associated with pregnancy | 10.20% (5/49) | 24.44% (11/45) | 0.066 |
Preeclampsia | 4.08% (2/49) | 15.56% (7/45) | 0.059 |
Hypertension | 10.20% (5/49) | 24.44% (11/45) | 0.066 |
HELLP | 0.00% (0/49) | 2.22% (1/45) | 0.294 |
Threatened preterm labor | 10.20% (5/49) | 20.00% (9/45) | 0.183 |
Urinary tract infection | 2.04% (1/49) | 8.89% (4/45) | 0.139 |
Neonatal gender | |||
F | 56.82% (25/44) | 47.62% (20/42) | 0.393 |
M | 43.18% (19/44) | 52.38% (22/42) | 0.393 |
Apgar score 1° minute | 8.00 (7.00–8.00) | 8.00 (6.00–8.75) | 0.637 |
Apgar score 5° minute | 9.00 (9.00–9.00) | 9.00 (8.00–9.00) | 0.205 |
PROM | 8.16% (4/49) | 6.67% (3/45) | 0.782 |
NICU hospitalization | 10.20% (5/49) | 20.00% (9/45) | 0.183 |
Neonatal Polycitemia | 0.00% (0/49) | 2.22% (1/45) | 0.294 |
Polihydramnios | 0.00% (0/49) | 4.44% (2/45) | 0.136 |
Oligohydramnios | 0.00% (0/49) | 4.44% (2/45) | 0.136 |
OR (CI.95) | p | aOR (CI.95) | p | |
---|---|---|---|---|
Composite outcome | ||||
Pre-pregnancy HbA1c > 7.0% | 3.57 (1.51–8.44) | <0.05 | 2.95 (1.16–7.48) | <0.05 (**) |
Components of the composite outcome | ||||
(1) Preterm delivery (<37 weeks’ gestation) | ||||
Pre-pregnancy HbA1c > 7.0% | 4.78 (1.69–13.54) | <0.05 | 4.93 (1.66–14.66) | <0.05 (ŧ) |
(2) SGA or LGA | ||||
Pre-pregnancy HbA1c > 7.0% | 1.81 (0.77–4.28) | 0.175 | 1.99 (0.82–4.84) | 0.130 (ŧ) |
(3) Intrauterine fetal demise or perinatal death | ||||
Pre-pregnancy HbA1c > 7.0% (*) | -- | -- | -- | -- |
(4) Neonatal symptomatic hypoglycemia | ||||
Pre-pregnancy HbA1c > 7.0% (*) | -- | -- | -- | -- |
(5) Congenital malformations | ||||
Pre-pregnancy HbA1c > 7.0% (*) | -- | -- | -- | -- |
(6) Pregnancy-related hypertensive disorders | ||||
Pre-pregnancy HbA1c > 7.0% | 2.85 (0.90–8.97) | 0.074 | 3.04 (0.94–9.77) | 0.062 (ŧ) |
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Xodo, S.; Londero, A.P.; D’Agostin, M.; Novak, A.; Galasso, S.; Pittini, C.; Baccarini, G.; Grimaldi, F.; Driul, L. Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes? Medicina 2021, 57, 461. https://doi.org/10.3390/medicina57050461
Xodo S, Londero AP, D’Agostin M, Novak A, Galasso S, Pittini C, Baccarini G, Grimaldi F, Driul L. Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes? Medicina. 2021; 57(5):461. https://doi.org/10.3390/medicina57050461
Chicago/Turabian StyleXodo, Serena, Ambrogio Pietro Londero, Martina D’Agostin, Alice Novak, Silvia Galasso, Carla Pittini, Giovanni Baccarini, Franco Grimaldi, and Lorenza Driul. 2021. "Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes?" Medicina 57, no. 5: 461. https://doi.org/10.3390/medicina57050461