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Association of higher HbA1c within the normal range with adverse pregnancy outcomes: a cross-sectional study

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Abstract

Objective

The aim of this study was to investigate the association between a relatively high HbA1c level within the normal range and the risk of adverse pregnancy outcomes.

Methods

This retrospective cohort study was conducted between March 2018 and March 2019 at Women’s Hospital, School of Medicine, Zhejiang University. Multiple logistic regression models after adjusting for plausible confounders were implemented to assess the relationships between the level of HbA1c and adverse pregnancy outcomes.

Results

A total of 8585 women were included in our study. The rates of preterm birth, macrosomia and preeclampsia were 4.4% (380/8585), 5.3% (457/8585) and 1.7% (149/8585), respectively. After adjusting for potential confounding variables, an HbA1c range of 5.5–5.9% (37–41 mmol/mol) remained significantly associated with an increased risk of preterm delivery (a-OR 2.27; 95% CI, 1.50–3.43), macrosomia (a-OR 1.97; 95% CI, 1.32–2.94) and preeclampsia (a-OR 3.70; 95% CI, 2.07–6.60). GDM-negative pregnant women with an HbA1c level in the range of 5.5–5.9% (37–41 mmol/mol) had an increased risk of preterm delivery (a-OR 2.84; 95% CI, 1.71–4.71) and preeclampsia (a-OR 3.82; 95% CI, 1.81–8.04). However, GDM-positive pregnant women had an increased risk of macrosomia (a-OR 2.12; 95% CI, 1.13–3.97) and preeclampsia (a-OR 2.62; 95% CI, 1.01–6.81).

Conclusion

A higher HbA1c level within the normal range is an independent risk factor for preterm delivery and preeclampsia, especially among GDM-negative women. Therefore, relevant medical staff should enhance the awareness of risk and prevention to strengthen pregnancy monitoring.

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Funding

This work was supported by the National Key R&D Program of China (grant number: 2018YFC1002702).

Author information

Authors and Affiliations

  1. Department of Clinical Laboratory, School of Medicine, Women’s Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China

    Binbin Yin, Xingjun Meng, Kaiqi Wu, Long Zhang, Yuning Zhu & Bo Zhu

  2. Department of Genetics and Metabolism, School of Medicine, The Children’s Hospital, Zhejiang University, ZheJiang 310058, Hangzhou, China

    Lingwei Hu

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  1. Binbin Yin
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  2. Lingwei Hu
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  6. Yuning Zhu
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  7. Bo Zhu
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Contributions

BBY and LWH were involved in conceptualization, investigation, data collection and analysis, and manuscript writing. XJM, KQW and LZ were involved in data collection and analysis and manuscript writing. YNZ and BZ were involved in conceptualization, investigation, funding acquisition, supervision, validation and manuscript editing.

Corresponding authors

Correspondence to Yuning Zhu or Bo Zhu.

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Conflicts of interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Ethical approval

This study was approved by the Medical Ethics Committee of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China (Approval number: IRB-20200037-R). Since this is a retrospectively observational study with no intervention, the Ethics Committee of Women's Hospital Affiliated to Zhejiang University School of Medicine has determined exemption for informed consent of the study participants.

Informed consent

Not applicable for this study.

Additional information

This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini

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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

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