Vinita Sarbhai1, Shibani Devi2
To explore the role of Glycosylated Haemoglobin (HbA1c) in predicting foetomaternal outcome in pregnant women with gestational diabetes mellitus (GDM).
This was a prospective study of 100 women with singleton pregnancy with <34 weeks of gestation with >140 mg/dL on glucose challenge test enrolled in Kasturba Hospital, Delhi, from 2012 to 2013. A detailed history, examination, routine obstetrical investigations including 75 g Oral Glucose Tolerance Test (OGTT) and HbA1c level were done. Patients were managed accordingly and followed till delivery. Their obstetrical and perinatal outcomes were noted and the data was compared using chi-squared test and Fischer’s exact test with a two-tailed p-value <0.05 being considered significant.
Foetomaternal outcomes were compared among patients with >6% HbA1c level and those with abnormal OGTT. Adverse maternal outcomes in patients with >6% HbA1c included excessive weight gain (68% vs. 58.2%), preeclampsia (44% vs. 38.2%), polyhydramnios (44% vs. 35.2%), caesarean section (68% vs. 52.9%), wound sepsis (24% vs. 17.6%) as compared to patients with abnormal GTT. Adverse foetal outcomes and neonatal complications in patients with >6% HbA1c included preterm delivery (36% vs. 32.3%), intrauterine death (12% vs. 8.8%), LGA babies (52% vs. 29.4%), congenital anomalies (13.6% vs. 9.6%), respiratory distress (27.3% vs. 16.1%), hypoglycaemia (36.8% vs. 25.8%), hyperbilirubinaemia (31.8% vs. 29%), and NICU admission >2 days (95.4% vs. 64.5%). A high HbA1c was found to be comparable to OGTT in predicting adverse maternal outcome in GDM patients while a poor foetal outcome was more commonly associated with HbA1c >6%.
HbA1c is a sensitive tool for prediction of foetomaternal outcomes in patients with abnormal blood glucose value; hence, it should be advised in all pregnant women.