title: Role of First-Trimester HbA1c as a Predictor of Adverse Obstetric Outcomes in a Multiethnic Cohort.
abstract: Risk of obstetric complications increases linearly with rising maternal glycemia. Testing hemoglobin A1c (HbA1c) is an effective option to detect hyperglycemia, but its association with adverse pregnancy outcomes remains unclear. Emerging data sustain that an early HbA1c ≥5.9% could act as a pregnancy risk marker.
  
  
  
  To determine, in a multiethnic cohort, whether an early ≥5.9% HbA1c could be useful to identify women without diabetes mellitus at increased pregnancy risk.
  
  
  
  A prospective study was conducted at Hospital del Mar, Barcelona, between April 2013 and September 2015.
  
  
  
  A total of 1631 pregnant women had an HbA1c measurement added to their first antenatal blood tests and were screened for gestational diabetes mellitus at 24 to 28 weeks' gestation.
  
  
  
  Primary outcome was macrosomia. Secondary outcomes were preeclampsia, preterm birth, and cesarean section rate.
  
  
  
  A total of 1228 pregnancies were included for outcome analysis. Women with HbA1c ≥5.9% (n = 48) showed a higher rate of macrosomia (16.7% vs 5.9%, P = 0.008) and a tendency toward a higher rate of preeclampsia (9.32% vs 3.9%, P = 0.092). There were no statistically significant differences in other pregnancy outcomes. After adjusting for potential confounders, an HbA1c ≥5.9% was independently associated with a 3-fold increased risk of macrosomia (95% confidence interval, 1.127 to 8.603, P = 0.028) and preeclampsia (95% confidence interval, 1.086 to 11.532, P = 0.036).
  
  
  
  In a multiethnic population, an early HbA1c ≥5.9% measurement identifies women at high risk for poorer pregnancy outcomes independently of gestational diabetes mellitus diagnosis later in pregnancy. Further studies are required to establish cutoff points adapted to each ethnic group and to assess whether early detection and treatment are of benefit.
authors.affiliation: Department of Endocrinology and Nutrition and.|Institut Hospital del Mar d'Investigacions Mèdiques, 08003, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Mañé
authors.affiliation: Department of Endocrinology and Nutrition and.|Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Juana Antonia
authors.initials: JA
authors.lastname: Flores-Le Roux
authors.affiliation: Department of Endocrinology and Nutrition and.|Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Benaiges
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Marcelo
authors.affiliation: Department of Endocrinology and Nutrition and.|Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Chillarón
authors.affiliation: Department of Endocrinology and Nutrition and.|Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Pedro-Botet
authors.affiliation: Department of Endocrinology and Nutrition and.
authors.forename: Gemma
authors.initials: G
authors.lastname: Llauradó
authors.affiliation: Department of Endocrinology and Nutrition and.
authors.forename: Lucía
authors.initials: L
authors.lastname: Gortazar
authors.affiliation: Department of Gynecology and Obstetrics, Hospital del Mar, 08003 Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Carreras
authors.affiliation: Department of Gynecology and Obstetrics, Hospital del Mar, 08003 Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Campus del Mar, 08003 Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Payà
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis / Q000208:ethnology; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000208:ethnology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D011261:Pregnancy Trimester, First; D047928:Premature Birth / Q000208:ethnology; D011295:Prenatal Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin