Abstract

CORRELATION OF HbA1C LEVEL IN LATE PREGNANCY WITH MATERNAL AND PERINATAL OUTCOME IN PATIENTS WITH GESTATIONAL DIABETES MELLITUS

Mohamed Hamed F. A.* and Abokresh Eisha G. A.

ABSTRACT

Gestational diabetes (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes including an increased risk for type 2 diabetes and cardiovascular disease later in life in mothers and an increased risk of macrosomia and obesity in offspring. Elevated HbA1c (A1C) is associated with increased risk of adverse pregnancy outcomes (e.g., abortion, stillbirth, and congenital abnormalities). However, a level of HbA1C below which further improvement will carry no benefit for the fetus has not been defined. In the present study, the predictive value of glycated hemoglobin (HbA1c) levels on the outcome of late pregnancy in patients with gestational diabetes mellitus (GDM) was investigated in Zliten Teaching Hospital, Libya from June 2019- August 2020. Samples of 144 females with GDM and 177 normal pregnant females as controls were selected for retrospective analysis. The following parameters were compared between the two groups: Levels of HbA1c maternal pregnancy outcome and adverse pregnancy rate. The predictive value of elevated HbA1c regarding an adverse pregnancy outcome was then determined. HbA1c levels in the GDM group were significantly higher than those in the control group (P<0.001). The adverse pregnancy rate in the GDM group was significantly higher than that in the control group (P<0.001). Logistic regression and receiver operating characteristics (ROC) analyses indicated that, in subjects with GDM and HbA1c levels were closely associated with adverse pregnancy outcomes (P<0.050) and may be considered as predictors for an adverse pregnancy outcome (risk ratio >1). According to ROC analysis, the combined predictive sensitivity of HbAlc for adverse pregnancy outcome in patients with GDM was 96.49% and the specificity was 77.19%. The increase in HbAlc levels is expected to be an effective predictor of adverse pregnancy outcomes in high-risk pregnant women. This was a prospective study with an aim to evaluate the role of HbA1c estimation in late pregnancy (Late third trimester) for prediction of pregnancy outcomes in GDM patients.

Keywords: Gestational diabetes mellitus, HbA1c, Late trimester, Libya.