The relationship between glycosylated hemoglobin A1c (HbA1c) levels and pregnancy complications in a diabetic pregnant women-Retrospective case-control study

Year 2022, Volume: 5 Issue: 3, 68 - 78, 30.12.2022

İsa Kaplan

https://doi.org/10.33713/egetbd.1079188

Abstract

Aim: To determine whether there is a relationship between glycosylated hemoglobin A1C (HbA1c) levels and complications that may occur during pregnancy in pregnant women with diabetes mellitus (DM).
Material-Methods: Our study is a retrospective case-control study. It was carried out in Aydın Adnan Menderes University hospital between January 2013 and December 2017. It was performed on 321 patients.
Results: HbA1c values were pregnant women's 4-5.9% in 66 , 6-7.9% in 157 HbA1c≥8% in 91. Compared to gestational diabetes mellitus (GDM), preeclampsia, fetal distress, preterm delivery, shoulder dystocia, and neonatal hypoglycemia were found more frequently in pregnant women with pregestational DM (p<0.05). Compared to type 2 DM, threatened premature birth (TPL), polyhydramnios, hyperbilirubinemia, neonatal hypoglycemia, and neonatal weight loss were found more frequently in pregnant women with type 1 DM (p<0.05). Compared to normal HbA1c values in pregnant women, GHT, preeclampsia, TPL, oligohydramnios, polyhydramnios, LGA, fetal distress, preterm birth, neonatal hypoglycemia, neonatal weight loss, neonatal respiratory distress, respiratory distress syndrome (RDS), hyperbilirubinemia and ex fetus were found more frequently in pregnant women with HbA1c≥8% and HbA1c beetwen 6-7.9% (p<0.05). In pregnants with GDM diagnosis with HbA1c>6% and HbA1c between 5-5.9%, GHT, preeclampsia, TPL, polyhydramnios, small for gestational age (SGA), LGA, fetal distress, preterm birth, neonatal hypoglycemia, and neonatal respiratory distress were found more frequently compared to pregnants with 4-4.9% HbA1c.
Conclusion: Obstetric complication rates increased in pregnant women with pregestational DM, Type 1 DM, GDMA2 and high HbA1c values.

Keywords

Glycolyzed Hemoglobin A1c (HbA1c), Pregnancy Complication, Gestational Diabetes Mellitus, Pregnancy in Diabetes

Diyabetik gebelerde glikolize hemoglobin A1c (HbA1c) düzeyi ile gebelik komplikasyonları arasındaki ilişki-Retrospektif vaka-kontrol çalışması

Abstract

Amaç: Diabetes mellitus (DM) tanılı gebelerde glikolize hemoglobin A1C (HbA1c) düzeyleri ile gebelikte meydana gelebilecek olan komplikasyonlar arasında ilişki olup olmadığını saptamak.
Gereç ve Yöntemler: Çalışmamız retrospektif vaka-kontrol çalışmasıdır. Ocak 2013 ve Aralık 2017 tarihleri arasında Aydın Adnan Menderes Üniversitesi hastanesinde yapılmıştır. Çalışmamız 321 hasta üzerinde yapılmıştır. Hastalarda HbA1C düzeyine göre komplikasyon oranlarına bakılmıştır.
Bulgular: HbA1c değerleri 66 gebede %4-5.9, 157 gebede %6-7.9 ve 91 gebede HbA1c≥%8’dir. Pregestasyonel DM tanılı gebelerde gestasyonel diabetes mellitus (GDM) tanılı gebelere kıyasla preeklampsi, fetal distres, preterm doğum, omuz distosisi ve yenidoğan hipoglisemisi daha sık saptanmıştır (p<0.05). Tip 1 DM tanılı gebelerde Tip 2 DM tanılı gebelere kıyasla erken doğum tehdidi (EDT), polihidroamnios, hiperbilirübinemi, yenidoğan hipoglisemisi ve yenidoğan kilo kaybı daha sık saptanmıştır (p<0.05). GDMA2 tanılı gebelerde GDMA1 tanılı gebelere kıyasla gestasyonel hipertansiyon (GHT), preeklampsi, EDT ve large for gestational age (LGA) daha sık saptanmıştır (p<0.05). GDMA1 tanılı gebelerde oligohidroamnios daha sık saptanmıştır (p<0.05). HbA1c≥%8 ve HbA1c %6-7.9 olan gebelerde HbA1c değeri normal olan gebelere kıyasla GHT, preeklampsi, EDT, oligohidroamnios, polihidroamnios, LGA, fetal distres, preterm doğum, yenidoğan hipoglisemisi, yenidoğan kilo kaybı, yenidoğan solunum sıkıntısı, respiratuar distres sendromu (RDS), hiperbilirübinemi ve intrauterin ex fetüs daha sık saptanmıştır (p<0.05). GDM tanılı HbA1c>%6 ve HbA1c %5-5.9 olan gebelerde HbA1c %4-4.9 arasında olan gebelere kıyasla GHT, preeklampsi, EDT, polihidroamnios, small for gestational age (SGA), LGA, fetal distres, preterm doğum, yenidoğan hipoglisemisi ve yenidoğan solunum sıkıntısı daha sık saptanmıştır (p<0.05).
Sonuç: Pregestasyonel DM, Tip 1 DM, GDMA2 ve yüksek HbA1c değeri olan gebelerde obstetrik komplikasyon oranlarında artma olduğu saptanmıştır.

Keywords

Glikolize hemoglobin A1c (HbA1c), Gebelik Komplikasyonu, Gestasyonel Diabetes Mellitus, Diyabette Gebelik

References

• 1. Strehlow SL, Greenspoon JS, Janzen C, Palmer SM. (Çev: Koç A, Güldoğan EC). Diabetes Mellitus ve Gebelik In: Decherney AH, Nathan L, Goodwın TM, Laufer N, (Çev. Edit: Tıraş B). Güncel Obstetrik ve Jinekoloji Tanı ve Tedavi. Ankara: Güneş Tip Kitabevleri; 2010: 311-7.
• 2. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991-2002. doi: 10.1056/NEJMoa0707943. PMID:18463375.
• 3. Weykamp C, John WG, Mosca A. A review of the challenge in measuring hemoglobin A1c. J Diabetes Sci Technol. 2009;3(3):439-445. Published 2009 May 1. doi:10.1177/193229680900300306
• 4. Kurt İ. Glikolize Hemoglobin (HbA1c) ölçümü ve diabetes mellitusun uzun dönem glisemik kontrolünde kullanılması. Gülhane Tip Dergisi 2003; 45 (4): 387-95.
• 5. Jeffcoate SL. Diabetes control and complications: the role of glycated haemoglobin, 25 years on. Diabet Med. 2004;21(7):657-665. doi:10.1046/j.1464-5491.2003.01065.x
• 6. Herman WH, Fajans SS. Hemoglobin A1c for the diagnosis of diabetes: practical considerations. Pol Arch Med Wewn. 2010;120(1-2):37-40.
• 7. Hiilesmaa V, Suhonen L, Teramo K. Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with type I diabetes mellitus. Diabetologia. 2000;43(12):1534-1539. doi:10.1007/s001250051565
• 8. Ekbom P, Damm P, Nøgaard K, et al. Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes. Diabetologia. 2000;43(7):927-931. doi:10.1007/s001250051471
• 9 Leslie RD, John PN, Pyke DA, White JM. Haemoglobin A1 in diabetic pregnancy. 1978. Lancet 958–959.
• 10. Dim CC, Okafor C, Ikeme AC, Anyahie BU. Diabetes mellitus in pregnancy: an update on the current classification and management. Niger J Med. 2012;21(4):371-376.
• 11. Jamieson EL, Spry EP, Kirke AB, et al. Prediabetes and pregnancy: Early pregnancy HbA1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes. Diabetes Res Clin Pract. 2021;176:108868. doi:10.1016/j.diabres.2021.108868
• 12. Murphy HR, Steel SA, Roland JM, et al. Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med. 2011;28(9):1060-1067. doi:10.1111/j.1464-5491.2011.03333.x
• 13. Bodmer-Roy S, Morin L, Cousineau J, Rey E. Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Obstet Gynecol. 2012;120(4):746-752. doi:10.1097/AOG.0b013e31826994ec
• 14. Sibai BM. Risk factors, pregnancy complications, and prevention of hypertensive disorders in women with pregravid diabetes mellitus. J Matern Fetal Med. 2000;9(1):62-65. doi:10.1002/(SICI)1520-6661(200001/02)9:1<62::AID-MFM13>3.0.CO;2-6
• 15. Holmes VA, Young IS, Patterson CC, et al. Optimal glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care. 2011;34(8):1683-1688. doi:10.2337/dc11-0244
• 16. Lapolla A, Dalfrà MG, Di Cianni G, et al. A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr Metab Cardiovasc Dis. 2008;18(4):291-297. doi:10.1016/j.numecd.2006.12.001
• 17. Yin, B., Hu, L., Meng, X. et al. Association of higher HbA1c within the normal range with adverse pregnancy outcomes: a cross-sectional study. Acta Diabetol 58, 1081–1089 (2021). https://doi.org/10.1007/s00592-021-01691-0
• 18. Temple, R., Aldridge, V., Stanley, K. and Murphy, H. (2006), Glycaemic control throughout pregnancy and risk of pre-eclampsia in women with type I diabetes. BJOG: An International Journal of Obstetrics & Gynaecology, 113: 1329-1332. https://doi.org/10.1111/j.1471-0528.2006.01071.x
• 19. Odsæter IH, Åsberg A, Vanky E, Carlsen SM. HbA1c as screening for gestational diabetes mellitus in women with polycystic ovary syndrome. BMC Endocr Disord. 2015;15:38. Published 2015 Aug 6. doi:10.1186/s12902-015-0039-9
• 20. Maresh MJ, Holmes VA, Patterson CC, et al. Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes. Diabetes Care. 2015;38(1):34-42. doi:10.2337/dc14-1755
• 21. Idris N, Wong SF, Thomae M, Gardener G, McIntyre DH. Influence of polyhydramnios on perinatal outcome in pregestational diabetic pregnancies. Ultrasound Obstet Gynecol. 2010;36(3):338-343. doi:10.1002/uog.7676
• 22. Deniz Karcaaltıncaba, Serdar Yalvaç, Ömer Kandemir & Serpil Altun (2010) İkinci trimesterdeki glikozillenmiş hemoglobin seviyesi, anormal tarama testi olan diyabetik olmayan gebeliklerde doğum ağırlığını ve amniyotik sıvı hacmini öngörür, The Journal of Maternal-Fetal & Neonatal Medicine, 23: 10, 1193-1199, DOI: 10.3109/14767050903511586
• 23. Sun B, Wang X, Song Q, Wang Y, Xue L, Wang C, Quan Z, Zhang Y, Niu P. Prospective studies on the relationship between the 50 gr glucose challenge test and pregnant outcome. Chin Med J (Engl) 1995; 108(12): 910-3.
• 24. Ho YR, Wang P, Lu MC, Tseng ST, Yang CP, Yan YH. Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women. PLoS One. 2017;12(5):e0177563. Published 2017 May 15. doi:10.1371/journal.pone.0177563
• 25. Barbry F, Lemaitre M, Ternynck C, et al. HbA1c at the time of testing for gestational diabetes identifies women at risk for pregnancy complications [published online ahead of print, 2021 Dec 18]. Diabetes Metab. 2021;48(3):101313. doi:10.1016/j.diabet.2021.101313
• 26. Pedersen JF, Mølsted-Pedersen L, Mortensen HB. Fetal growth delay and maternal hemoglobin A1c in early diabetic pregnancy. Obstet Gynecol. 1984;64(3):351-352.
• 27. Teramo K, Ammälä P, Ylinen K, Raivio KO. Pathologic fetal heart rate associated with poor metabolic control in diabetic pregnancies. Obstet Gynecol. 1983;61(5):559-565.
• 28. Lemaitre M, Ternynck C, Bourry J, Baudoux F, Subtil D, Vambergue A. Association Between HbA1c Levels on Adverse Pregnancy Outcomes During Pregnancy in Patients With Type 1 Diabetes. J Clin Endocrinol Metab. 2022;107(3):e1117-e1125. doi:10.1210/clinem/dgab769
• 29. Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998;152(3):249-254. doi:10.1001/archpedi.152.3.249
• 30. Marles SL, Casiro OG. Persistent neonatal hypoglycemia: Diagnosis and management. Paediatr Child Health. 1998;3(1):16-19. doi:10.1093/pch/3.1.16