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Continuous Glucose Monitoring System Profile of Women Stratified Using Different Levels of Glycated Hemoglobin (HbA1c) in Early Pregnancy: A Cross-sectional Study

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Abstract

Aim

To evaluate the differences in the continuous glucose monitoring system (CGMS) profiles of women in early pregnancy stratified based on different HbA1c levels known to be predictive of gestational diabetes mellitus (GDM) at 24–28 weeks of gestation (≥ 5.2%) and adverse pregnancy outcomes (≥ 5.5%) in Indian women.

Methods

 We enrolled women at 8+ 0 to 19+ 6 weeks of gestation (early pregnancy), evaluated the glycaemic parameters of clinical interest using CGMS, and reported them per standard methodology proposed by Hernandez et al. WHO 2013 criteria were used for diagnosis of early GDM.

Results

Ninety-six women were enrolled at 14.0 ± 3.2 weeks of gestation. Of these, 38 were found to have early GDM (diagnosed before 20 weeks of gestation) on evaluation. Of 96 women, 33 (34.4%) had HbA1c value ≥ 5.5% [11 (19.0%) with normoglycaemia and 22 (57.9%) with GDM]. The women with elevated HbA1c differed significantly from those with HbA1c < 5.5% for all evaluated parameters. The differences for overall women were > 10 mg/dl (0.56 mmol/l) for 1-h postprandial glucose (difference of 0.78 mmol/l), 2-h postprandial glucose (difference of 0.59 mmol/l), peak postprandial glucose (difference of 0.75 mmol/l), and 1-h postprandial glucose excursion (difference of 0.59 mmol/l). Of 58 women with normoglycaemia, 29 (50.0%) had an HbA1c value  ≥ 5.2%. In comparison, in the normoglycaemic group of women with and without HbA1c ≥ 5.2% (known to be predictive of future GDM), the results were significant for 1-h (difference of 0.44 mmol/l), 2-h (difference of 0.278 mmol/l), and peak postprandial glucose (difference of 0.35 mmol/l).

Conclusions

 The results suggest that women with elevated HbA1c (≥ 5.5%) in early pregnancy significantly differ from those with HbA1c < 5.5% in all glycaemic parameters evaluated in this study, suggesting that HbA1c at this cut-off has a role to play in early pregnancy.

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Acknowledgements

The authors thank study participants for generously donating their time and information. The authors thank Yatender Singh, Ankit Rajput, Balram, Arun Kumar, and Sandhya Sharma for assistance in conducting the study. The authors also acknowledge the contributions of faculty and resident doctors of the Department of Obstetrics and Gynaecology and Department of Endocrinology and Metabolism, AIIMS, New Delhi, who were involved in care of these women and helped in recruitment of the participants.

Funding

No funding or sponsorship was received for this study or publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authors’ Contributions

Yashdeep Gupta conceptualised this paper and wrote the first draft. Charandeep Singh and Yashdeep Gupta were involved in conceptualisation of research and its execution. Mani Kalaivani provided inputs in the statistical part. All authors contributed to manuscript editing and its final approval for publication of this work. Yashdeep Gupta is the guarantor of this work and has full access to the data.

Disclosures

Yashdeep Gupta, Charandeep Singh, Alpesh Goyal, Mani Kalaivani, Neerja Bhatla, and Nikhil Tandon have nothing to disclose.

Compliance with Ethics Guidelines

The study was approved by the institutional ethics committee of the All India Institute of Medical Sciences, New Delhi, India (reference no. IECPG-96/22.03.2017 dated 24.03.2017), and informed consent was obtained from all participants. The study was conducted in accordance with the International Conference on Harmonisation Guidelines for Good Clinical Practice and the Declaration of Helsinki.

Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India

    Yashdeep Gupta, Charandeep Singh, Alpesh Goyal & Nikhil Tandon

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    Mani Kalaivani

  3. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

    Neerja Bhatla

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  1. Yashdeep Gupta
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Correspondence to Yashdeep Gupta.

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Gupta, Y., Singh, C., Goyal, A. et al. Continuous Glucose Monitoring System Profile of Women Stratified Using Different Levels of Glycated Hemoglobin (HbA1c) in Early Pregnancy: A Cross-sectional Study. Adv Ther 40, 951–960 (2023). https://doi.org/10.1007/s12325-022-02405-w

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