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Women with an HbA 1c of 41–49 mmol/mol (5.9–6.6%): a higher risk subgroup that may benefit from early pregnancy intervention
Author(s) -
Rowan J. A.,
Budden A.,
Ivanova V.,
Hughes R. C.,
Sadler L. C.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12812
Subject(s) - medicine , gestational diabetes , gestation , pregnancy , obstetrics , diabetes mellitus , gestational age , gestational hypertension , subgroup analysis , eclampsia , gynecology , endocrinology , confidence interval , genetics , biology
Aims To examine whether women with an HbA 1c of 41–49 mmol/mol (5.9–6.6%) at diagnosis of gestational diabetes are higher risk than women with an HbA 1c of < 41 mmol/mol (5.9%) and whether pregnancy outcomes are improved if treated at < 24 weeks' gestation. Methods This was an observational study of women with gestational diabetes diagnosed by early HbA 1c screening or subsequent oral glucose tolerance test at < 34 weeks' gestation who delivered at National Women's Health, Auckland, from July 2012 to June 2014. Data were extracted from the hospital database. Women with HbA 1c 41–49 mmol/mol (5.9–6.6%) were divided into those seen < 24 weeks (Early, n = 134) and those seen ≥ 24 weeks (Later, n = 151). Those with HbA 1c < 41 mmol/mol (5.9%) were labelled Other GDM ( n = 661). Results The Early and Later groups, compared with Other GDM , had more Polynesian and fewer (non‐Indian) Asian women, higher BMI and more required medication ( P < 0.001). More were smokers ( P = 0.007, 0.02) and more had chronic hypertension ( P < 0.001, 0.02). There were higher rates of adverse outcomes in the Later group than the Other GDM group (pre‐eclampsia 8.0% vs. 2.4%, P = 0.001, preterm birth 16.6% vs. 8.2%, P = 0.002, neonatal admission 15.5% vs. 9.2%, P = 0.02). Outcomes were similar between the Early group and Other GDM group (pre‐eclampsia 1.5% vs. 2.4%, P = 0.5, preterm birth 10.5% vs. 8.2% P = 0.4, neonatal admission 13.6% vs. 9.2%, P = 0.12). Comparing the Early and Later groups, the Early group had less pre‐eclampsia, 1.5% vs. 8.0%, adjusted P = 0.03. Other outcomes were not statistically different. Conclusions An HbA 1c of 41–49 mmol/mol (5.9–6.7%) identifies a higher‐risk group of women with gestational diabetes. Overall, our data support early treatment of women with an HbA 1c ≥ 41 mmol/mol (5.9%).