The association between HbA1c level in the 2nd and 3rd trimesters and the development of maternal and neonatal complications in women with gestational diabetes compared to non-gestational diabetes
Keywords:
Gestational diabetes mellitus, HbA1c, Maternal complications, Neonatal outcomesAbstract
Gestational diabetes mellitus (GDM) increases the risk of maternal and neonatal complications. HbA1c levels in the second and third trimesters serve as indicators of these complications. This cohort study aims to determine the relationship between HbA1c levels in the second and third trimesters and maternal and neonatal outcomes in both GDM and non-GDM pregnant women. The study involved 94 mothers (47 with GDM and 47 without GDM) at Detudom Crown Prince Hospital. HbA1c levels were measured in the second trimester (20–28 weeks) and the third trimester (34–38 weeks), and maternal and neonatal outcomes were compared using log-binomial regression. Additionally, the HbA1c cutoff values were analyzed using ROC curves. Results showed significantly higher second-trimester HbA1c levels in the GDM group compared to the non-GDM group (5.13 ± 1.16 vs. 4.71 ± 0.43; p = 0.02). Third-trimester HbA1c levels also trended higher (5.24 ± 0.61 vs. 5.00 ± 0.59; p = 0.05) but were not statistically significant. Neonates in the GDM group had a significantly higher risk of hypoglycemia (34.04% vs. 4.26%; adj. RR = 6.73, 95% CI: 1.50–30.02) and a higher incidence of hyperbilirubinemia (44.68% vs. 21.28%; adj. RR = 1.96, 95% CI: 0.87–4.42), though the latter was not significant. Optimal HbA1c cut-offs were 4.85 in the second trimester (sensitivity 53%, specificity 51%, ROC 0.52) and 5.35 in the third trimester (sensitivity 47%, specificity 75%, ROC 0.61). In conclusion, second-trimester HbA1c levels were significantly higher in the GDM group, and neonates of GDM mothers were at higher risk of hypoglycemia. However, low ROC values (<0.7) highlight the limitations of using HbA1c alone for predicting complications. Additional risk factors should be considered to improve predictive accuracy.
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