title: Hemoglobin A1c in pregestational diabetic gravidas and the risk of congenital heart disease in the fetus.
abstract: This study aimed to determine whether poor glycemic control in early pregnancy is associated with an increased risk of congenital heart disease (CHD) for infants of women with preexisting diabetes. A retrospective review examined two tertiary care centers of diabetic pregnancies that recorded early hemoglobin A1c (HbA1c) values (<20 weeks). The incidence of prenatally diagnosed CHD was calculated and stratified by HbA1c level. Poor glycemic control was defined as an HbA1c level of 8.5 % or higher. Fetal echocardiography was used to identify fetuses that resulted in infants with suspected CHD. Neonatal echocardiograms and pathology reports were reviewed for confirmation of the diagnosis. Of 535 patients, 30 (5.6 %) delivered an infant with confirmed CHD. Among the patients with poor glycemic control, 8.3 % (n = 17) delivered an infant with CHD, whereas 3.9 % (n = 13) of those with an HbA1c level lower than 8.5 % delivered an infant with CHD (p = 0.03). Poor glycemic control in early pregnancy is associated with an increased risk of CHD in offspring. The incidence of CHD in patients with adequate glycemic control still is sufficiently high to justify routine fetal echocardiography for all gravidas with preexisting diabetes regardless of HbA1c level.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital of RI and The Warren Alpert Medical School of Brown University, Providence, RI, USA, roman.s.starikov@medstar.net.
authors.forename: Roman
authors.initials: R
authors.lastname: Starikov
authors.forename: Justin
authors.initials: J
authors.lastname: Bohrer
authors.forename: William
authors.initials: W
authors.lastname: Goh
authors.forename: Melissa
authors.initials: M
authors.lastname: Kuwahara
authors.forename: Edward K
authors.initials: EK
authors.lastname: Chien
authors.forename: Vrishali
authors.initials: V
authors.lastname: Lopes
authors.forename: Donald
authors.initials: D
authors.lastname: Coustan
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006330:Heart Defects, Congenital / Q000196:embryology* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin