Elevated Glycosylated Hemoglobin (HbA1c) in First Trimester and Its Implications in Pregnancy Outcome

Article Type: Original Article
Authors: Snehitha Sai, Jayaraman Nambiar, Shripad Hebbar


Background: Glycosylated Hemoglobin (HbA1c) and fasting blood glucose are commonly used to screen for overt diabetes in the first trimester of pregnancy. The purpose of the study was to determine whether elevated glycosylated hemoglobin (HbA1c) values in the first trimester were associated with the development of gestational diabetes mellitus (GDM) later in pregnancy.Materials and Methods: All patients underwent first-trimester screening for diabetes mellitus with HbA1c. Patients were followed up and all underwent GTT at 24–28 weeks. All women received regular antenatal visits, regardless of GDM status, were followed up until delivery. The study included several outcome measures such as GDM, pre-eclampsia, polyhydramnios, mode of delivery, and neonatal measures such as birth weight, LGA, hyperbilirubinemia and hypoglycemia.Results: Out of 510 subjects, 104 (20.4%) developed GDM. In retrospect, there was a significant difference in HbA1c values, with a p-value of <0. 001 with a mean HbA1c of 5.22 ± 0.34% in patients who developed GDM. There is a positive correlation between HbA1c and large for gestational age with a mean of 5.19 ± 0.41%. No association was noted with polyhydramnios and gestational hypertension, preterm delivery, hyperbilirubinemia. At HbA1c level of 5.15% or higher predicted GDM with 65.4% sensitivity and 64.8% specificity.Conclusion: Raised level of HbA1c in the first trimester of pregnancy is associated with a higher chance of GDM and macrosomia in pregnancy.

Keywords: Glycosylated hemoglobin, Gestational diabetes mellitus, Macrosomia, Overt diabetes mellitus.
Issue Number: 2   May - August 2023
Pages: 30 - 57
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