Markers of Glycemic Control and Neonatal Morbidity in High-Risk Insulin-Resistant Pregnancies

American Journal of Perinatology
Alison G CahillGeorge A Macones

Abstract

This study aims to determine whether fructosamine, glycated hemoglobin A1C (HbA1c), or mean fasting glucose levels associate with birth outcomes in diabetic women. A prospective cohort study of women with singleton, nonanomalous pregnancies and diagnosis of diabetes (gestational or pregestational). Daily average self-measured fasting serum glucose levels were collected, as well as HbA1c and fructosamine levels at delivery. The primary outcome was neonatal composite morbidity, defined as having one or more of the following: respiratory distress syndrome, hyperbilirubinemia, perinatal death, shoulder dystocia, and hypoglycemia requiring treatment. Secondary outcomes included macrosomia (≥ 4,000 g). Among neonates delivered by 301 study-eligible women (97 with gestational and 204 with pregestational diabetes), incidences of composite morbidity (n = 147, 48.8%) and macrosomia (n = 49, 16.3%) were high. Macrosomia occurred more frequently in infants of pregestational than gestational diabetic mothers (22.7 vs. 13.2%, p = 0.04), composite morbidities were not significantly different (52.2 vs. 42.3%, p = 0.14). HbA1c > 8.0 significantly increased risk of morbidity and macrosomia (relative risk, 4.29; 95% confidence interval, 1.62-11.3...Continue Reading

Citations

Aug 16, 2018·Frontiers in Endocrinology·Sofia NahavandiElif I Ekinci

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