title: Elevated glycated hemoglobin predicts macrosomia among Asian Indian pregnant women (WINGS-9).
abstract: OBJECTIVE
  The aim of this study was to determine the optimal glycated hemoglobin (HbA1c) cut point for diagnosis of gestational diabetes mellitus (GDM) and to evaluate the usefulness of HbA1c as a prognostic indicator for adverse pregnancy outcomes.
  
  
  METHODS
  HbA1c estimations were carried out in 1459 pregnant women attending antenatal care centers in urban and rural Tamil Nadu in South India. An oral glucose tolerance test was carried out using 75 g anhydrous glucose, and GDM was diagnosed using the International Association of the Diabetes and Pregnancy Study Groups criteria.
  
  
  RESULTS
  GDM was diagnosed in 195 women. Receiver operating curves showed a HbA1c cut point of ≥ 5.0% (≥31 mmol/mol) have a sensitivity of 66.2% and specificity of 56.2% for identifying GDM (area under the curve 0.679, confidence interval [CI]: 0.655-0.703). Women with HbA1c ≥ 5.0% (≥31 mmol/mol) were significantly older and had higher body mass index, greater history of previous GDM, and a higher prevalence of macrosomia compared to women with HbA1c < 5.0% (<31 mmol/mol). The adjusted odds ratio for macrosomia in those with HbA1c ≥ 5.0% (≥31 mmol/mol) was 1.92 (CI: 1.24-2.97,P= 0.003). However, other pregnancy outcomes were not significantly different.
  
  
  CONCLUSIONS
  In Asian Indian pregnant women, a HbA1c of 5.0% (31 mmol/mol) or greater is associated with increased risk of macrosomia.
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Balaji
authors.initials: B
authors.lastname: Bhavadharini
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Manni Mohanraj
authors.initials: MM
authors.lastname: Mahalakshmi
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Deepa
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Ranjani
authors.initials: R
authors.lastname: Harish
authors.affiliation: Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
authors.forename: Belma
authors.initials: B
authors.lastname: Malanda
authors.affiliation: Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
authors.forename: Arivudainambi
authors.initials: A
authors.lastname: Kayal
authors.affiliation: Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Belton
authors.affiliation: Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Ponnusamy
authors.initials: P
authors.lastname: Saravanan
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Unnikrishnan
authors.initials: U
authors.lastname: Ranjit
authors.affiliation: Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Ram
authors.initials: R
authors.lastname: Uma
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.affiliation: Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
keywords: Adverse pregnancy outcomes; Asian Indians; South Asians; glycated hemoglobin; macrosomia