Association of Improved Periconception Hemoglobin A1c With P
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Prepregnancy diabetes is associated with higher perinatal and maternal morbidity, especially if periconception glycemic control is suboptimal. It is not known whether improved glycemic control from preconception to early pregnancy and mid-pregnancy periods can reduce the risk of adverse perinatal and maternal outcomes. A study was conducted To determine whether a net decline in glycated hemoglobin A1c (HbA1c) from preconception to the first half of pregnancy is associated with a lower risk of adverse outcomes for mother and child.

A total of 3459 births were included, with a mean (SD) maternal age of 32.6 years at conception. Overall, the mean (SD) hemoglobin A1c decreased from 7.2% preconception to 6.4% in early pregnancy to mid-pregnancy. There were 497 pregnancies with a congenital anomaly, with an adjusted relative risk of 0.94 per 0.5% net decrease in hemoglobin A1c, including for cardiac anomalies. The risk was also reduced for preterm birth. Severe maternal morbidity or death occurred among 191 women (5.5%), with an aRR of 0.90 per 0.5% net decrease in hemoglobin A1c.

The main outcome was a congenital anomaly from birth to age 1 year. Other outcomes included preterm birth or perinatal mortality among offspring as well as severe maternal morbidity (SMM) or death among mothers. Adjusted relative risks (aRRs) were calculated per 0.5% absolute net decline in hemoglobin A1c from preconception up to early pregnancy and mid-pregnancy, adjusting for maternal age at conception, preconception hemoglobin A1c, and hemoglobin concentration, and gestational age at hemoglobin A1c measurement.

Conclusions and Relevance These findings suggest that women with prepregnancy diabetes who achieve a reduction in HbA1c may have improved perinatal and maternal outcomes. Further study is recommended to determine the best combination of factors, such as lifestyle changes and/or glucose-lowering medications, that can influence periconception HbA1c reduction.