title: Can hemoglobin A1c in early pregnancy predict adverse pregnancy outcomes in diabetic patients?
abstract: OBJECTIVE
  To examine the association of elevated early pregnancy hemoglobin A1c (HbA1c) levels with adverse pregnancy outcomes in women with preexisting diabetes mellitus.
  
  
  METHODS
  Retrospective cohort study of 330 women with preexisting diabetes enrolled in a Diabetes in Pregnancy Program at an academic institution between 2003 and 2011 who had an early HbA1c determination. The frequencies of composite maternal adverse pregnancy outcomes (birth at<37 weeks, preeclampsia, and medically indicated birth <39 weeks), and composite fetal adverse pregnancy outcomes [shoulder dystocia, Apgar scores<7 at 5 minutes, small for gestational age (SGA), large for gestational age (LGA), and stillbirth] were compared between HbA1c categories (<6.5, 6.5-7.4, 7.5-8.4 and ≥ 8.5%).
  
  
  RESULTS
  There was no statistically significant difference between composite adverse maternal pregnancy outcomes and composite adverse fetal pregnancy outcomes as well as other individual outcomes between different HbA1c categories. Of the vaginally delivered women in our cohort, the 37 patients with HbA1c levels of ≥ 8.5% had a significantly higher frequency of fetal shoulder dystocia than the 62 with HbA1c levels of < 8.5% (24.2 vs. 1.6%, P = 0.002). Neonates of patients with HbA1c ≥ 8.5% were more likely to have low five minute Apgar scores than neonates of patients with HbA1c < 8.5%, but this was of borderline statistical significance (7.4% vs. 0.5%, P = 0.05).
  
  
  CONCLUSIONS
  In patients with preexisting diabetes mellitus, HbA1c levels of ≥ 8.5% during early pregnancy are not useful in predicting most adverse outcomes, although there may be an increased risk for shoulder dystocia.
authors.affiliation: Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806. Electronic address: rstarikov@wihri.org.
authors.forename: Roman S
authors.initials: RS
authors.lastname: Starikov
authors.affiliation: Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
authors.forename: Kyle
authors.initials: K
authors.lastname: Inman
authors.affiliation: Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
authors.forename: Edward K S
authors.initials: EK
authors.lastname: Chien
authors.affiliation: Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Anderson
authors.affiliation: Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: The Warren Alpert Medical School of Brown University, Providence, RI 02806; Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital of RI.
authors.forename: Vrishali
authors.initials: V
authors.lastname: Lopes
authors.affiliation: Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Coustan
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D011247:Pregnancy / Q000097:blood; D011256:Pregnancy Outcome / Q000453:epidemiology; D011261:Pregnancy Trimester, First / Q000097:blood*; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Adverse pregnancy outcome; Hemoglobin A1c; Pre-existing diabetes mellitus; Shoulder dystocia