HbA1c Early in Diabetic Pregnancy Predicts Outcomes

In women with diabetes, increasing hemoglobin A1c (HbA1c) levels in early pregnancy are associated with increasing risk of adverse pregnancy outcomes, according to a new report. " Dr. Gunnar L. Nielsen told Diabetes in Control.com that, "Lowering of HbA1c seems to be associated with a reduced risk of adverse fetal outcome through a wider range of HbA1c values than previously thought.”

Dr. Nielsen and colleagues from Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark investigated the clinical utility of first-trimester HbA1c level in predicting adverse outcomes in 537 pregnancies in women with type 1 diabetes.

HbA1c levels averaged 7.4% in pregnancies with a good outcome, the team reports, compared with 8.5% in the 165 pregnancies that had an adverse outcome — i.e., spontaneous or therapeutic abortion, stillbirth, neonatal death, or congenital anomaly.

There was a consistently positive, almost linear association between increasing HbA1c levels and the risk of adverse pregnancy outcome beginning at an HbA1c level slightly below 7.0%, the results indicate.

In a logistic regression model, each 1% increase in HbA1c corresponded to a 5.5% increase in risk of having an adverse outcome.

However, HbA1c was not very helpful in predicting outcome of individual pregnancies. For example, 21% of pregnancies with HbA1c above 10% had a good outcome, while 15% of pregnancies with HbA1c less than 6% had an adverse outcome.
"Although the association between HbA1c and outcome intuitively seems to be strong, it is obvious that other factors must be in play," Dr. Nielsen said.

"This means that although we as physicians must stress the strong evidence for improved pregnancy outcome associated with lowering of HbA1c, we must still be aware that many pregnancies with high HbA1c values in fact end happily," Dr. Nielsen concluded.

Diabetes Care 2006;29:2612-2616.

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