Haemoglobin A1 and congenital malformation

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Medical Genetics

Background:

• Diabetes in pregnancy poses risks for fetal development.
• Glycemic control, particularly in early pregnancy, is crucial for preventing birth defects.

Purpose of the Study:

• To investigate the association between first-trimester maternal hemoglobin A1 (HbA1) levels and the occurrence of congenital malformations in infants of diabetic women.
• To evaluate the utility of antenatal screening for malformations in this high-risk population.

Main Methods:

• A cohort study of 230 pregnancies in 196 diabetic women.
• Analysis of first-trimester maternal HbA1 levels in relation to fetal malformation outcomes.
• Review of antenatal diagnoses and outcomes.

Main Results:

• A higher median first-trimester HbA1 was observed in women whose babies had major malformations (12.9%) compared to those with normal babies (10.8%).
• No significant association was found between minor malformations and first-trimester HbA1.
• Two major malformations were detected antenatally, allowing for therapeutic abortion discussions.

Conclusions:

• Elevated first-trimester HbA1 in diabetic pregnancies is linked to an increased risk of major congenital malformations.
• Expert antenatal ultrasound screening is essential for all pregnant diabetic women.
• Poor glycemic control during conception and organogenesis is a significant risk factor for congenital malformations.