Establishing Trimester-Specific Haemoglobin A1c Reference Intervals in Pregnant Women: A retrospective study of healthy South Asian women with normal pregnancy outcomes.

Objectives: This study aimed to define trimester-specific haemoglobin A1c (HbA1c) reference intervals in healthy, pregnant South Asian women. Methods: This retrospective study was conducted at St. Stephen's Hospital, Delhi, India, between January 2011 and December 2016. Healthy pregnant women were compared to a control group of healthy non-pregnant women. Pregnant participants had term deliveries of babies with appropriate gestational weights. The HbA1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2) and third (T3) trimester groups. Statistical tests were used to obtain the normal HbA1c reference values and were considered significant when P <0.05. Results: This study included a total of 1,357 healthy pregnant women and a control group of 67 healthy, non-pregnant women. Pregnant women had a median HbA1c of 4.8% (4-5.5%) or 32 mmol/mol (20-39 mmol/mol); non-pregnant women had a median HbA1c of 5.1% (4-5.7%) or 29 mmol/mol (20-37 mmol/mol; P <0.001). The HbA1c levels for the T1, T2 and T3 groups were 4.9% (4.1-5.5%) or 30 mmol/mol (21-37 mmol/mol), 4.8% (4.5-5.3%) or 29 mmol/mol (20-34 mmol/mol) and 4.8% (3.9-5.6%) or 29 mmol/mol (19-38 mmol/mol), respectively. The HbA1c values were significant when comparing T1 versus T2 (P <0.001), T1 versus T3 (P = 0.002) and T1 versus the non-pregnant group (P = 0.001). However, T2 versus T3 was not significant (P = 0.111). Conclusion: Compared to non-pregnant women, HbA1c levels were lower in pregnant women, despite women in the T2 and T3 groups having a higher body mass index than the women in the T1 and non-pregnant groups. Further research is recommended to understand the factors responsible and validate these findings.

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment.

AIM: To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis. METHODS: This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)-diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM- No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable. RESULTS: Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed. CONCLUSIONS: Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.

Is HbA1c in the first trimester associated with adverse outcomes among pregnant Asian Indian women without gestational diabetes?

AIMS: The aim of this study is to determine the association of elevated HbA1c in the first trimester (HbA1c-FT) with adverse events among pregnant Asian Indian women without gestational diabetes (GDM). METHODS: This retrospective cohort study included 1618 pregnant women who delivered at a single urban tertiary care center and had HbA1c-FT estimation between January 2011 and September 2017. Those with GDM according to a 75-g OGTT after 24 gestational weeks were excluded. Multivariable logistic regression models assessed the association between elevated HbA1c-FT and adverse events. RESULTS: At a cutoff of ≥37 mmol/mol (5.5%), HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10, 95% CI 1.11-3.98). There was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol (0.5%) increase in HbA1c-FT for primary caesarean delivery: 1.27, 95% CI 1.06-1.52). In the crude analysis, gestational hypertension was associated with HbA1c-FT, but not after adjustment for confounding factors. HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications). CONCLUSIONS: Even without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women.

Prevalence of 'Hyperglycemia in pregnancy' remained stable between 2006 and 2015, despite rise in conventional risk factors: A hospital based study in Delhi, North India.

AIMS: Between 2006 and 2015, the trends in prevalence of Hyperglycemia in pregnancy (HIP); Gestational diabetes (GDM), Diabetes in Pregnancy (DIP), Pre existing diabetes (PDM) and GDM risk factors were studied in 30,692 pregnancies among Asian Indian women. METHODS: GDM (n = 4089) and DIP (n = 259) diagnoses were by 75 g OGTT, while PDM (n = 103) was identified by ICD code O24. Women with DIP and PDM were grouped together as pre-gestational diabetes (PGDM n = 362). Crude and age-adjusted prevalence trend analysis by Poisson and Jointpoint regression models respectively, were done in GDM and PGDM groups. RESULTS: During study years, the GDM prevalence by WHO 1999 and modified IADPSG criteria, showed decreasing and static trends respectively, while PGDM prevalence remained static. In a subgroup of 2560 women, mean BMI increased from 24.12 ± 4.16 in year 2011 to 25.18 ± 4.7 Kg/m2 in 2015 (p < 0.014), but this rise had no impact on GDM prevalence. GDM risk factors; maternal age, gravidity ≥3, previous GDM and abortion, high income, diabetes and hypertension in family, were higher in 2011-2015 than in 2006-2010 period. On multivariate analysis, BMI was not an independent GDM risk factor. CONCLUSION: Despite rise in conventional GDM risk factors, HIP prevalence was static for a decade among pregnant Asian Indian women.