Markers of Glycemic Control and Neonatal Morbidity in High-Risk Insulin-Resistant Pregnancies.
OBJECTIVE
This study aims to determine whether fructosamine, glycated hemoglobin A1C (HbA1c), or mean fasting glucose levels associate with birth outcomes in diabetic women.


METHODS
A prospective cohort study of women with singleton, nonanomalous pregnancies and diagnosis of diabetes (gestational or pregestational). Daily average self-measured fasting serum glucose levels were collected, as well as HbA1c and fructosamine levels at delivery. The primary outcome was neonatal composite morbidity, defined as having one or more of the following: respiratory distress syndrome, hyperbilirubinemia, perinatal death, shoulder dystocia, and hypoglycemia requiring treatment. Secondary outcomes included macrosomia (≥ 4,000 g).


RESULTS
Among neonates delivered by 301 study-eligible women (97 with gestational and 204 with pregestational diabetes), incidences of composite morbidity (n = 147, 48.8%) and macrosomia (n = 49, 16.3%) were high. Macrosomia occurred more frequently in infants of pregestational than gestational diabetic mothers (22.7 vs. 13.2%, p = 0.04), composite morbidities were not significantly different (52.2 vs. 42.3%, p = 0.14). HbA1c > 8.0 significantly increased risk of morbidity and macrosomia (relative risk, 4.29; 95% confidence interval, 1.62-11.3).


CONCLUSIONS
Late third-trimester HbA1c, but not fructosamine or mean blood glucose levels, was associated with increased morbidity in infants of diabetic mothers. Third-trimester HbA1c could be clinically useful for counseling regarding neonatal risks in women with diabetes.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
Alison G
AG
Cahill
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
Methodius G
MG
Tuuli
Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
Ryan
R
Colvin
Department of Medicine, Washington University in St Louis, St. Louis, Missouri.
W Todd
WT
Cade
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
George A
GA
Macones
D000328:Adult; D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000378:metabolism*; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D019270:Fructosamine / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000453:epidemiology; D007003:Hypoglycemia / Q000453:epidemiology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D066087:Perinatal Death; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000378:metabolism*; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human