Correlation of HbA1c and outcome of pregancy in Insulin dependent diabetic women

1 Akhlaghi F, 2 Rajabian R, 3 Talebi F

1Associate Professor, Obstetrician& Gynecologist , Ob&Gyn Dep, Emam Reza Hospital, 2Professor, Endocrine sub specialist, Ghaem Hospital, 3Medical student, Zeinab Hospital, Mashhad university of Medical Sciences

Objective: Diabetes mellitus increases the risk of important adverse outcomes of pregnancy.The aim of this study is to investigate correlation of maternal, perinatal, and neonatal outcomes of pregnancy with mean of HbA1c in insulin dependent diabetic women.

Material and Method: This prospective study was performed in thirty one of insulin dependent diabetic women who cared in Khorasan diabetic research center between October 2003 to October 2004. Age, parity, duration of diabetes, mean blood glucose, mean HbA1c and type of delivery in these women were assessed. Prenatal care, control of maternal blood glucose levels and assessment of fetal well-being was done and HbA1c in each trimester was measured. Patients divided in four groups by blood glucose and HbA1c levels. Maternal complications included pre- eclampsia, polyhydroamnios, preterm labor and diabetic retinopaty and Perinatal/fetal outcome including abortion, intrauterine fetal death, congenital malformation, hypocalcaemia,hypoglycemia`andrespiratory distress was studied. To complete the data set and reviewed the standard antenatal sheets of all women included in the study, then collecting data analyzed by SPSS software and P value less than 5% was significant.

Results: The mean age of women was 24.5 years old (between 18-32). Mean of Hba1c in the mothers determined and they devided in four groups. (Table 1). Relation between abortion and mean HbA1c determined and 2 abortion was seen (6.7%). Congenital malformations was seen alone in one ( 7.7%). Unexplained intrauterine fetal death was seen 5 cases. (Table 2) Preterm labor 8 cases were seen. Totally 26.7% of newborn preterm labored that 5 cases in HbA1c less than 8% and 3 cases in HbA1c greater than 8%, the difference was significant. Macrocosmic newborn was seen 2 cases (6.7%). In newborns respiratory distress 2 cases (6.7%), Neonatal hypoglycemia 4 cases (13.3%) and poly hydroamnious (6.7%) was happened.( Table 3) Retinopaty in one women with HbA1c 10% and greater was seen. Method of delivery in 22 cases was cesarean section (74.2%) and in 4 cases ( 12.9%) was spontaneous vaginal delivery.

Conclusion: Correlation between HbA1c and fetal/neonatal and maternal complications is important. Probability abortion, congenital malformations, macrosomia, fetal death, neonatal hypoglycemia, pre-eclampsia, polyhydroamnius, preterm labor and diabetic retinopathy increased in HbA1c greater than normal.