The prevalence of pregestational diabetes mellitus (PGDM) among women of reproductive age has increased globally by leading to a significant rise in adverse pregnancy outcomes. Hemoglobin A1c (HbA1c) is a critical marker for diagnosing and monitoring PGDM and plays a vital role in determining the risk of congenital anomalies and complications based on its levels during the periconceptional period.
A recent study published in The Israel Medical Association Journal evaluated the association between periconceptional HbA1c levels and perinatal complications in pregnant women with poorly controlled PGDM. This retrospective analysis covered pregnancies from 2010 to 2019 and focused on women with HbA1c levels greater than 6% three months prior to conception or during the first trimester.

The study cohort consisted of a total of 89 women divided into three groups based on their HbA1c levels; 49 women with HbA1c between 6-8%, 29 women with HbA1c between 8-10% and 11 women with HbA1c levels over 10%. It was observed that higher HbA1c levels were more prevalent among women with type 1 diabetes who also showed an elevated risk of end-organ damage.
Women with increased HbA1c levels underwent unbalanced glucose levels during pregnancy that contributes to various complications. The group expressed high rates of preterm delivery, hypertensive disorders, cesarean deliveries and neonatal intensive care unit (NICU) admissions. Despite these challenges, the overall live birth rate was close to 83%.
A significant correlation was found between higher HbA1c levels and preterm delivery. However, no consistent association was observed between HbA1c levels and other adverse outcomes like hypertensive disorders or NICU admissions. This suggests that while higher HbA1c levels are associated with certain risks, the escalation of complications does not always follow a proportional pattern beyond a specific HbA1c threshold.

The findings illuminate the importance of maintaining optimal glycemic control during the periconceptional period for women with PGDM. Increased HbA1c levels are associated with increased risks of adverse pregnancy outcomes that emphasizes the need for vigilant monitoring and management of blood glucose levels before and during pregnancy. Overall, the study highlights the major role of HbA1c as a predictive marker for pregnancy complications in women with PGDM ad clinicians are urged to prioritize glycemic control in reproductive-age women with diabetes to reduce the risks associated with high HbA1c levels.
Source:
Gelman, M., Galperin, T., Maor-Sagie, E., Yoeli, Y., Hallak, M., Gabbay-Benziv, R., & Naeh, A. (2024). Pregnancy Outcomes in Women with Poorly Controlled Pregestational Diabetes Mellitus. The Israel Medical Association Journal : IMAJ, 26(6), 376-382.