Glycohemoglobins in normal and diabetic pregnancy

Glycosylated hemoglobin (HbA1) concentration was measured in 155 pre- and 30 postpartum patients to study its correlation with glucose metabolism and perinatal outcome in patients suspected of carbohydrate intolerance during pregnancy. Though the mean HbA1 values were significantly higher in gestational diabetics compared to normal pregnant controls, the large overlap between HbA1 levels of diabetic patients and levels in the of normal range, make HbA1 an unreliable screening device for diabetes. However, if the HbA1 level was elevated in patients suspected of carbohydrate intolerance, but who had a normal glucose tolerance test, the perinatal outcome in terms of macrosomia and neonatal metabolic abnormalities was similar to that of the group with gestational diabetes. HbA1 measurements should be obtained in these women, and, if elevated, maternal and fetal surveillance is recommended. HbA1 level is not a useful predictor of birthweight, though may be of value as a postpartum screen for unrecognized diabetes and may help discriminate between a constitutionally large but otherwise normal newborn and a large infant of a diabetic mother.