Glycosylated hemoglobin as predictor of adverse fetal outcome in type 1 diabetic pregnancies.
The study aimed to determine whether a consistent dose-response association can be demonstrated, after adjustment for maternal age and White classification, between glycosylated hemoglobin (HbA1c) values before conception and in the first trimester of pregnancy of insulin-dependent diabetic mothers and adverse fetal outcome (abortions and major malformations). This is a historical follow-up study based on medical records in a geographically defined catchment area. The study comprised 60 pregnancies with HbA1c determinations before pregnancy and 161 with HbA1c in the first trimester in women with type 1 diabetes admitted between 1980 and 1992. Relative risk calculations indicated a highly significant and consistent correlation between HbA1c values above 6.6% and adverse fetal outcome after adjustment for differences in maternal age and White classification. Our data support a clinically significant and consistent relationship between adverse fetal outcome and HbA1c in the first trimester of pregnancy of type 1 mothers, without any indication of a cut-off level below which further improvement in HbA1c was of minor importance.
Nielsen
G L
GL
Department of Obstetrics, Aalborg Hospital, Denmark.
Sørensen
H T
HT
Nielsen
P H
PH
Sabroe
S
S
Olsen
J
J
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First / Q000097:blood / Q000378:metabolism; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D006442:Glycated Hemoglobin