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To determine a threshold, third trimester hemoglobin A1C (HbA1C) that predicts adverse maternal and neonatal outcomes.
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.
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.
1Outcomes by high and low HbA1C
A HbA1C >5.3 % appears to predict poor pregnancy outcomes for mother and neonate and might be used as a management goal.