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Poster session II Clinical obstetrics, diabetes, labor, medical-surgical-disease, physiology/endocrinology, prematurity: Abstracts 237 - 386| Volume 208, ISSUE 1, SUPPLEMENT , S117, January 01, 2013

255: Can a threshold third trimester hemoglobin A1C be used to predict maternal and neonatal pathology?

      Objective

      To determine a threshold, third trimester hemoglobin A1C (HbA1C) that predicts adverse maternal and neonatal outcomes.

      Study Design

      This was a retrospective cohort study of 157 women who delivered 169 singleton infants at Vidant Medical Center between 2007 and 2012 who had either gestational (48%) or pre-existing diabetes (52%). The primary outcome was whether or not the infant was discharged home with mother. Secondary outcomes included macrosomia/ large for gestational age infants, intrauterine fetal demise, neonatal intensive care admission, intravenous treatment of hypoglycemia (<40 mg%), hyperbilirubinemia (>12mg%), and shoulder dystocia. Maternal primary outcomes included preeclampsia and unintended cesarean section. A ROC analysis was performed to determine the threshold HbA1C that would predict a composite adverse neonatal outcome including any one of the latter outcomes.

      Results

      Our population was typically obese (Table), African-American or hispanic (68%), and indigent. 74% of the term patients went home with their neonates and 22% of term neonates were admitted to the NICU. Our ROC analysis identified a threshold of HbA1C of 5.3 %. There were no significant differences in age, parity, or DM class among the low and high HbA1C classes. The Table depicts the differences in outcomes above and below a third trimester HbA1C of 5.3%. We found a significant difference in the HbA1C between those that had any secondary outcome present compared to those where all adverse outcomes were absent.
      Tabled 1Outcomes by high and low HbA1C
      Table thumbnail grr16

      Conclusion

      A HbA1C >5.3 % appears to predict poor pregnancy outcomes for mother and neonate and might be used as a management goal.