Baseline HbA1c to Identify High Risk Gestational Diabetes: Utility in Early Versus Standard Gestational Diabetes
Abstract
Context: The increasing prevalence of gestational diabetes mellitus (GDM) necessitates risk stratification directing limited antenatal resources to those at greatest risk. Recent evidence demonstrates that an early pregnancy glycated hemoglobin (HbA1c ≥5.9% (41 mmol/mol) predicts adverse pregnancy outcomes. Objective: To determine the optimal HbA1c threshold for adverse pregnancy outcomes in GDM in a treated multiethnic cohort and whether this differs in women diagnosed <24 vs ≥24 weeks' gestation (early vs standard GDM). Design and Setting: This was a retrospective cohort study undertaken at the Royal Prince Alfred Hospital Diabetes Antenatal Clinic, Australia, between 1991 and 2011. Patients and Interventions: Pregnant women (N = 3098) underwent an HbA1c (single-laboratory) measurement at the time of GDM diagnosis. Maternal clinical and pregnancy outcome data were collected prospectively. Main Outcome Measure: The association between baseline HbA1c and adverse pregnancy outcomes in early vs standard GDM. Results: HbA1c was measured at a median of 17.6 ± 3.3 weeks' gestation in early GDM (n = 844) and 29.4 ± 2.6 weeks' gestation in standard GDM (n = 2254). In standard GDM, HbA1c >5.9% (41 mmol/mol) was associated with the greatest risk of large-for-gestational-age (odds ratio [95% confidence interval] = 2.7 [1.5-4.9]), macrosomia (3.5 [1.4-8.6]), cesarean section (3.6 [2.1-6.2]), and hypertensive disorders (2.6 [1.1-5.8]). In early GDM, similar HbA1c associations were seen; however, lower HbA1c correlated with the greatest risk of small-for-gestational-age (P trend = 0.004) and prevalence of neonatal hypoglycemia. Conclusions: Baseline HbA1c >5.9% (41 mmol/mol) identifies an increased risk of large-for-gestational-age, macrosomia, cesarean section, and hypertensive disorders in standard GDM. Although similar associations are seen in early GDM, higher HbA1c levels do not adequately capture risk-limiting utility as a triage tool in this cohort.
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Observational studies demonstrate that intermediate hyperglycaemia (HbA1c ≥ 6.0-6.4% [≥ 42-47 mmol/mol]) is associated with elevated risk of pregnancy complications.
“Observational studies demonstrate that intermediate hyperglycaemia (HbA1c ≥ 6.0‐6.4% [≥ 42–47 mmol/mol]) is associated with elevated risk of pregnancy complications. 43 , 44 , 45 , 46”
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- Authors
- Sweeting, A. N., Ross, G. P., Hyett, J., Molyneaux, L., Tan, K., Constantino, M., Harding, A. J., & Wong, J.
- Affiliations
- The University of Sydney (AU)
- Royal Prince Alfred Hospital (AU)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2016-10-31
- Volume
- 102
- Issue
- 1
- Pages
- jc.2016-2951
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2540756184
- Cited by
- 47
- References
- 19
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 8 · 2023: 3 · 2022: 4 · 2021: 13 · 2020: 1 · 2019: 7 · 2018: 5 · 2017: 2
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- gestational diabetes mellitus, HbA1c, HbA1c thresholds, risk stratification, adverse pregnancy outcomes, large for gestational age, macrosomia, cesarean section, hypertensive disorders of pregnancy, small for gestational age, neonatal hypoglycemia
- MeSH terms
- Adult, Australia, Birth Weight, Blood Glucose, Cesarean Section, Female, Follow-Up Studies, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Infant, Newborn, Infant, Newborn, Diseases, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prospective Studies, Retrospective Studies, Risk Factors, Biomarkers, Diabetes, Gestational
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