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Pregnancy Outcomes in Women with Poorly Controlled Pregestational Diabetes Mellitus

Milana Gelman1, Tzipora Galperin2, Esther Maor-Sagie1

  • 1Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

The Israel Medical Association Journal : IMAJ
|June 17, 2024
PubMed

Insights

Poorly controlled pregestational diabetes mellitus (PGDM) in pregnancy is linked to adverse outcomes. While elevated Hemoglobin A1c (HbA1c) increases preterm delivery risk, other complications may not proportionally escalate beyond a certain level.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Perinatal Medicine

Background:

  • Rising global prevalence of pregestational diabetes mellitus (PGDM) in women of reproductive age.
  • Increased adverse pregnancy outcomes associated with PGDM.
  • Hemoglobin A1c (HbA1c) as a key marker for PGDM diagnosis and monitoring, influencing pregnancy risks.

Purpose of the Study:

  • To assess the association between periconceptional HbA1c levels and perinatal complications.
  • Focus on pregnant women with poorly controlled PGDM.
  • Investigate the impact of glycemic control on pregnancy outcomes.

Main Methods:

  • Retrospective analysis of prospectively collected data (2010-2019).
  • Inclusion criteria: HbA1c > 6% prior to conception or in the first trimester.
  • Comparison of outcomes based on periconceptional HbA1c levels.

Main Results:

  • Cohort of 89 women with varying HbA1c levels (6-8%, 8-10%, >10%).
  • Higher HbA1c associated with type 1 diabetes and end-organ damage.
  • Significant correlation between HbA1c and preterm delivery; other outcomes showed no consistent association.
  • High rates of preterm delivery, hypertensive disorders, C-section, and NICU admission observed.

Conclusions:

  • Effective periconceptional glycemic control is crucial in PGDM pregnancies.
  • Elevated HbA1c levels correlate with increased risks of adverse pregnancy outcomes.
  • Risk escalation may plateau beyond a specific HbA1c threshold.
Abstract

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