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- W4200423563 abstract "Pregestational diabetes confers an increased risk of adverse maternal and neonatal outcomes. Glycaemic control in the medium and long term is commonly evaluated by examining glycosylated haemoglobin (HbA1c). However the value of HbA1c in pregnancy may be diminished by increased red cell turnover characteristic of pregnancy. We sought to examine the impact of HbA1c in first trimester, at term, and the change throughout on mode of delivery and birthweight in pregnancies complicated by diabetes. This was a retrospective study over 11 years from Jan 2010 until Dec 2020. Data were obtained from hospital records. First trimester HbA1c and corresponding peripartum level were determined. We noted gestation at delivery, mode of delivery and birthweight centile. 441 women were included for analysis. The median [IQR] HbA1c levels at first trimester, delivery and change were 48[19], 42[11] and -5[13]. A statistically significant reduction in HbA1c was observed(p < 0.001). The median birthweight centile was 85. Scatterplots and correlations of HbA1c level and birthweight centiles are presented in Figure 1. The distributions in HbA1c and birthweight centiles were heavily skewed (Figure 1, main diagonal). First trimester and delivery HbA1c were moderately correlated (r=0.66), change in HbA1c had a strong negative correlation with first trimester results (r= -0.72), but uncorrelated with delivery results (r= -0.02). The correlation between delivery HbA1c and birthweight centiles was positive but weak (r=0.35). 47% of women underwent scheduled caesarean delivery, 16% emergency CD, 9% were operative vaginal and 29% were spontaneous vaginal. Summaries of Hba1c levels are presented in Table 1. No correlation was found between mode of delivery and HbA1c. Neither baseline HbA1c, term values, nor trends across gestational age appear to impact birthweight centile or mode of delivery in pregestational diabetes. While optimising glycaemic control can affect the long term health of mother and child, these values cannot be relied upon to reflect the impact of glycaemic control on fetal growth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W4200423563 date "2022-01-01" @default.
- W4200423563 modified "2023-09-23" @default.
- W4200423563 title "Glycosylated hemoglobin is not a useful tool in reflecting fetal growth aberrations in diabetes pregnancy" @default.
- W4200423563 doi "https://doi.org/10.1016/j.ajog.2021.11.1242" @default.
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