The Relationship between Glycosylated Hemoglobin, Gestational Weight and Pregnancy Outcome in Patients with Gestational Diabetes

Zhou Xin^1, , Lin Tong¹, Zhang Qingye¹ and Zhao Xia¹

¹Nutritional Department, Beijing Jishuitan Hospital, Beijing, China

Cite this paper:
Zhou Xin, Lin Tong, Zhang Qingye and Zhao Xia. The Relationship between Glycosylated Hemoglobin, Gestational Weight and Pregnancy Outcome in Patients with Gestational Diabetes. Journal of Food and Nutrition Research. 2022; 10(6):409-414. doi: 10.12691/jfnr-10-6-4

Abstract

Purpose: To observe the relationship between the level of glycosylated hemoglobin (HbA1c) during pregnancy and the incidence of gestational diabetes mellitus (GDM) and the outcome of pregnancy in GDM patients. Methods: There were 334 pregnant women with GDM and 366 pregnant women with normal blood glucose selected into our research who had undergone regular check-ups and deliveries in our hospital from October 2018 to October 2019. Results: (1) Pregnant women with overweight and obesity before pregnancy have higher HbA1c in the first and third trimesters than those with normal and low weight before pregnancy (P<0.05). And the pregnancy of excessive weight gain during the second and third trimester and the total weight excessive gain pregnancy were statistically significant in HbA1c of third trimesters (P<0.05). (2) HbA1c in early pregnancy is a risk factor for the onset of GDM (OR=4.591, 95%CI 2.504-8.418). And the prediction critical point of GDM prediction of HbA1c in early pregnancy is 5.25%. (3) Logistic multivariate regression analysis found that HbA1c in the third trimester of pregnancy was the risk factor of adverse outcome of pregnancy including hypertensive disorders of pregnancy (OR=3.997, 95%CI 1.697-9.411), cesarean section (OR=2.024, 95%CI 1.179-3.474), and macrosomia (OR=2.261, 95%CI 1.198-4.267). Conclusion: The detection of HbA1c in early pregnancy helps to screen high-risk pregnancy of GDM and intervene them earlily. And HbA1c in the third trimester can help predict adverse pregnancy outcomes.

Keywords:
glycosylated hemoglobin gestational diabetes mellitus adverse pregnancy outcome

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References:

[1]	Lin Xiaolan, Lai Qiaohong, Liang Lixia. Effect of pregnancy weight management on newborn birth weight and pregnancy outcome. Chinese Medical Innovation. 2020; 17 (4): 20-22.
[2]	Obstetrics Group of Obstetrics and Gynecology Credit Association of Chinese Medical Association, Collaborative Group of Pregnancy Complicated with Diabetes, Perinatal Medicine Branch of Chinese Medical Association. Guidelines for Diagnosis and Treatment of Pregnancy Complicated with Diabetes (2014). Chinese Journal of Obstetrics and Gynecology. 2014; 49 (8): 561-569.
[3]	Beifan Zhou, Coorperative Meta-Analysis Group Of China Obesity Task Force. Predictive values of body mass index andwaist circumference to risk factors of related diseases in Chinese adult population. Zhonghua Liu Xing Bing Xue Za Zhi. 2002; 23(1): 5-10.
[4]	INSTITUTE OF MEDICINE (IOM): Weight gain during pregnancy: reexamining the guidelines[M]. Washington DC: National Academy Press, 2009.
[5]	Rong Chunhong, Liang Jing, Huang Juan, et al. Relationship between body weight before pregnancy, early and middle pregnancy and gestational diabetes. Journal of Sino-Japanese Friendship Hospital. 2020; 34 (2): 67-73.
[6]	Lu Chen, Gaia Pocobelli, Onchee Yu, Susan M Shortreed, Sarah S Osmundson, Sharon Fuller, et al. Early Pregnancy Hemoglobin A1C and Pregnancy Outcomes: A Population-Based Study. American journal of perinatology. 2019; 36(10): 1045-1053.
[7]	Benaiges D, Flores-Le Roux JA, Marcelo I, et al. Is first-trimester HbA1c useful in the diagnosis of gestational diabetes? Diabetes Res Clin Pract. 2017; 133: 85-91.
[8]	Lynn P Lowe, Boyd E Metzger, Alan R Dyer, Julia Lowe, David R McCance, Terence R J Lappin, Elisabeth R Trimble, Donald R Coustan, David R Hadden, Moshe Hod, Jeremy J N Oats, Bengt Persson, HAPO Study Cooperative Research Group; Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes care.2012; 35(3): 574-80.
[9]	Ke XQ, Xia XW, Zhang ZY, et al. Prediction of gestational diabetes mellitus and pregnancy outcome by screening HbAlc in the second and third trimester of pregnancy. Chinese Journal of Family Planning. 2020; 28 (2): 277-283.
[10]	PENG Yan-xia, LU Li-yan, YUAN Xue-rong. Effect of gestational weight gain on fetal growth and pregnancy outcome in pregnant women with gestational diabetes mellitus. Internal Medicine. 2020; 15 (1): 20-22.
[11]	Stefanie Brunner, Lynne Stecher, Stephanie Ziebarth, Ina Nehring, Sheryl L Rifas-Shiman, Christine Sommer, et al. Excessive gestational weight gain prior to glucose screening and therisk of gestational diabetes: a meta-analysis. Diabetologia. 2015; 58(10): 2229-2237.
[12]	Qiong Wei, Zilin Sun, Yue Yang, Hong Yu, Hongjuan Ding, Shaohua Wang. Effect of a CGMS and SMBG on maternal and neonatal outcomes in gestational diabetes mellitus: a randomized controlled trial. Scient Rep. 2016; 27(6): 19920.
[13]	Shigemitsu Yasuda, Takujiro Iuchi, Atsushi Goto, Kota Katanoda, Shinichiro Iida, Yoichi Oikawa, et al. Weight control before and during pregnancy for patients with gestational diabetes mellitus. Journal of diabetes investigation. 2019; 10(4): 1075-1082.
[14]	C B Parellada, B Asbjörnsdóttir, L Ringholm, P Damm, E R Mathiesen. Fetal growth in relation to gestational weight gain in women with type 2 diabetes: an observational study. Diabetic medicine: a journal of the British Diabetic Association. 2014; 31(12): 1681-9.
[15]	Jianing Bi, Cunwei Ji, Yuntao Wu, Mingyang Wu, Yunyun Liu, Lulu Song, et al. Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes. The Journal of clinical endocrinology and metabolism. 2020; 105(6).
[16]	Víctor Hugo González-Quintero, Niki B Istwan, Debbie J Rhea, Lorna I Rodriguez, Amanda Cotter, Jena Carter, Antoaneta Mueller, Gary J Stanziano; The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes. Diabetes care 2007 Mar; 30(3): 467-70.
[17]	Laura Mañé, Juana Antonia Flores-Le Roux, David Benaiges, Marta Rodríguez, Irene Marcelo, Juan José Chillarón, et al. Role of First-Trimester HbA1c as a Predictor of Adverse Obstetric Outcomes in a Multiethnic Cohort. The Journal of clinical endocrinology and metabolism. 2017; 102(2): 390-397.
[18]	Multicenter survey of diabetic pregnancy in France. Gestation and Diabetes in France Study Group. Diabetes care. 1991; 14(11): 994-1000.
[19]	Arianne N Sweeting, Glynis P Ross, Jon Hyett, Lynda Molyneaux, Kris Tan, Maria Constantino, Anna Jane Harding, Jencia Wong; Baseline HbA1c to Identify High-Risk Gestational Diabetes: Utility in Early vs Standard Gestational Diabetes. The Journal of clinical endocrinology and metabolism. 2017; 102(1): 150-156.
[20]	Laura Mañé, Juana Antonia Flores-Le Roux, Nàdia Gómez, Juan José Chillarón, Gemma Llauradó, et al. Association of first-trimester HbA1c levels with adverse pregnancy outcomes in different ethnic groups. Diabetes research and clinical practice. 2019; 150: 202-210.
[21]	Beatriz Barquiel, Lucrecia Herranz, Natalia Hillman, Ma Ángeles Burgos, Cristina Grande, Keleni M Tukia, et al. HbA1c and Gestational Weight Gain Are Factors that Influence Neonatal Outcome in Mothers with Gestational Diabetes. Journal of women's health (2002). 2016; 25(6): 579-85.
[22]	Noriyuki Iwama, Takashi Sugiyama, Hirohito Metoki, Masatoshi Saito, Tetsuro Hoshiai, Zen Watanabe, et al. Associations between glycosylated hemoglobin level at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan: The Japan Environment and Children's Study (JECS).Diabetes research and clinical practice. 2020; 169: 108377.
[23]	B Barquiel, L Herranz, C Grande, I Castro-Dufourny, M Llaro, P Parra, M A Burgos, L F Pallardo; Body weight, weight gain and hyperglycaemia are associated with hypertensive disorders of pregnancy in women with gestational diabetes. Diabetes & metabolism 2014 Jun; 40(3): 204-10.
[24]	Chen Wang, Yumei Wei, Xiaoming Zhang, Yue Zhang, Qianqian Xu, Yiying Sun, et al. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. American journal of obstetrics and gynecology. 2017; 216(4): 340-351.
[25]	Zhang Jianyang. Relationship between glycosylated hemoglobin level of pregnant women with gestational diabetes mellitus and maternal and fetal adverse pregnancy outcomes. China Health Care Nutrition. 2020; 30 (33): 127.
[26]	YANG Huan, SHENG Min-min, HU Mingzhu. Relationship between serum HbA1c, RBP4 and adiponectin levels in the third trimester of pregnancy and pregnancy outcomes in patients with gestational diabetes. Journal of Clinical and Experimental Medicine. 2020; 19 (17): 1845-1847.
[27]	Wang XJ, Tan XF, Ding XJ, et al. Relationship between body mass index, blood glucose, glycosylated hemoglobin levels of pregnant women with gestational diabetes mellitus and newborn birth weight. Jilin Medicine. 2020; 41 (12): 2827-2830.
[28]	ZHU Xiaolei. Correlation analysis of glycosylated hemoglobin level in early and middle pregnancy and pregnancy outcome. Journal of Practical Medicine. 2020; 37 (8): 701-704.