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Association between hemoglobin A1c trajectory during pregnancy and adverse birth outcomes among non-gestational diabetic women

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Abstract

Aims

Previous studies have shown that higher hemoglobin A1c (HbA1c) levels within the normal range during pregnancy can increase the risk of adverse birth outcomes. However, the effects of the longitudinal HbA1c trajectory during pregnancy on adverse birth outcomes among non-gestational diabetic women are poorly characterized. We aimed to identify HbA1c trajectory during pregnancy among non-gestational diabetic women and to estimate their associations with adverse birth outcomes.

Methods

Data was extracted from the Information System of Guangdong Women and Children Hospital, China, from January 2017 to July 2022. This study involved 13,979 women who did not have gestational diabetes mellitus and underwent repeated HbA1c measurements during pregnancy. Latent mixture modeling was used to identify HbA1c trajectory groups. Logistic regression was applied to explore the associations between HbA1c trajectory groups and adverse birth outcomes, including preterm delivery, low birth weight, macrosomia, small for gestational age, and large for gestational age (LGA).

Results

Three HbA1c trajectory groups were identified: low-stable (range 4.0% [20 mmol/mol]–4.4% [25 mmol/mol]), moderate-stable (range 4.6% [27 mmol/mol]–5.1% [32 mmol/mol]), and elevated-increasing (range 5.0% [31 mmol/mol]–5.6% [38 mmol/mol]). Compared with the low-stable HbA1c group, the elevated-increasing group had a higher risk of preterm delivery and LGA. The adjusted OR (95% CIs) were 1.67 (1.13, 2.49) and 1.47 (1.01, 2.12) for preterm delivery and LGA, respectively.

Conclusions

Among non-gestational diabetic women, the elevated-increasing HbA1c trajectory group was associated with a higher risk of preterm delivery and LGA. This finding emphasizes the importance of maintaining optimal HbA1c levels throughout pregnancy.

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Funding

This study was supported by the National Natural Science Foundation of China (82073660, 82003479) and China Postdoctoral Science Foundation (2019M662646, 2020T130220).

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Author notes

  1. Jing Peng and Li Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China

    Jing Peng, Li Zhang, Lijuan Zheng, Zixia Mai, Guozhen Chen & Guocheng Liu

  2. Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China

    Lulu Song, Qing Liu, Jianing Bi, Xiya Qin, Qing Fang, Gaojie Fan & Youjie Wang

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  1. Jing Peng
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Contributions

JP and LZ conceived the study and drafted the manuscript. GJF and GCL critically reviewed the manuscript. All authors provided substantial contributions to the interpretation of data, made critical revisions to the manuscript and approved the final manuscript.

Corresponding authors

Correspondence to Gaojie Fan or Guocheng Liu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was conducted following the Helsinki Declaration, and the study protocol was approved by the ethics committee of the Guangdong Women and Children Hospital (Approval Number 202201203).

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As all data used in this study was de-identified, no written informed consent was obtained.

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Peng, J., Zhang, L., Zheng, L. et al. Association between hemoglobin A1c trajectory during pregnancy and adverse birth outcomes among non-gestational diabetic women. Acta Diabetol (2024). https://doi.org/10.1007/s00592-024-02283-4

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