Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes

Abstract

Abstract Context Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence regarding the association between higher glycated hemoglobin A1c (HbA1c) within the normal range and adverse birth outcomes is limited. Objective We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. Design and Setting The data were abstracted from the Information System of Guangdong Women and Children Hospital, China, from September 2014 to March 2018. Patients A total of 5658 pregnant women with normal gestational HbA1c were included in this analysis. Main Outcome Measures The adverse birth outcomes include preterm birth, macrosomia, and large for gestational age (LGA). Results Among 5658 subjects, the rates of preterm birth, macrosomia, and LGA were 4.6% (261/5658), 3.5% (200/5658), and 5.7% (325/5658), respectively. The results of multivariate logistic regression model showed that each 1% increase in maternal HbA1c was positively associated with increased risks of preterm birth (OR 1.58; 95% CI, 1.08-2.31), macrosomia (OR 1.70; 95% CI, 1.10-2.64), and LGA (OR 1.38; 95% CI, 0.98-1.96). The association between gestational HbA1c and preterm birth was more evident among women with prepregnancy body mass index (BMI) ≤ 24 kg/m2. Conclusions Gestational higher HbA1c level within the normal range is an independent risk factor for preterm birth, macrosomia, and LGA. Intervention for reducing HbAc1 may help to prevent adverse birth outcomes.