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Predictive Value of Maternal HbA1c Levels for Fetal Hypertrophic Cardiomyopathy in Pregestational Diabetic

Angel Chimenea1,2,3, Ana María Calderón4, Guillermo Antiñolo1,2,3,5

  • 1Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/Consejo Superior de Investigaciones Científicas (CSIC)/University of Seville, 41004 Seville, Spain.

Children (Basel, Switzerland)
|March 28, 2025
PubMed

Insights

First-visit HbA1c levels effectively predict fetal hypertrophic cardiomyopathy (FHCM) in women with pregestational diabetes mellitus (PGDM). Early glycemic control is crucial for preventing FHCM and improving pregnancy outcomes.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Fetal Medicine

Background:

  • Pregestational diabetes mellitus (PGDM) poses risks to fetal development.
  • Fetal hypertrophic cardiomyopathy (FHCM) is a serious complication associated with maternal diabetes.
  • Predictive markers for FHCM in diabetic pregnancies are essential for early intervention.

Purpose of the Study:

  • To evaluate the predictive utility of first-visit HbA1c for FHCM in women with PGDM.
  • To determine the association between glycemic control and FHCM incidence.
  • To identify optimal HbA1c thresholds for risk stratification.

Main Methods:

  • Retrospective observational cohort study of pregnant women with PGDM (2012-2019).
  • Analysis of first-visit HbA1c levels and correlation with FHCM diagnosis.
  • Receiver-operating characteristic (ROC) curve analysis to assess predictive performance.

Main Results:

  • 5.8% of participants had fetuses diagnosed with FHCM.
  • Women with FHCM had significantly higher pregestational and first-visit HbA1c levels.
  • FHCM fetuses showed higher incidence of macrosomia (OR 9.20).
  • First-visit HbA1c demonstrated adequate predictive capacity (AUC 0.75) with an optimal threshold of 7.15%.

Conclusions:

  • First-visit HbA1c is a valuable predictor of FHCM in women with PGDM.
  • Optimizing glycemic control before and during pregnancy is critical for reducing FHCM risk.
  • Defined HbA1c cutoffs aid in risk stratification and targeted interventions for FHCM.

Keywords:
diabetes mellitushypertrophic cardiomyopathymaternal healthobstetric outcomes

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