ECE2019 Guided Posters Gestational and Type 1 Diabetes (11 abstracts)
Definition of a third-trimester HbA1c cut-off point for an increased risk of Large-for-Gestational-Age in mothers with Gestational Diabetes
Liliana Fonseca 1 , Diana Borges Duarte 1 , Ana Amado 1 , Eva Lau 1, , Fernado Pichel 1 , Joaquim Gonçalves 1 , Clara Pinto 1 , Joana Vilaverde 1 , Jorge Dores 1 & Helena Cardoso 1
1Centro Hospitalar e Universitário do Porto, Porto, Portugal; 2Centro Hospitalar de São João, Porto, Portugal.
Introduction: Gestational diabetes mellitus (GDM) is associated with important neonatal risks and a higher incidence of large-for-gestational-age (LGA) newborns and fetal macrosomia. The aim of our work was to define a third-trimester HbA1c cut-off point for increased risk of fetal morbidity, macrosomia and LGA newborns.
Methodology: Observational retrospective study of all singleton pregnant women with GDM, followed at our Diabetes and Pregnancy Clinic between 2011 and 2017. Excess gestational weight gain was defined by the IOM guidelines. Adverse neonatal outcome included: neonatal respiratory distress, neonatal hypoglycemia, neonatal jaundice, shoulder dystocia, fractures, Erb’s palsy and admission to neonatal intensive care unit. ROC curve was used to define the third-trimester HbA1c cut off point for increased risk of fetal morbidity, macrosomia and incidence of LGA.
Results: A total of 1085 singleton pregnant women were evaluated during the study period; their mean age was 32.9±5.3 years and mean body mass index (BMI) of 26.5±5.6 Kg/m2. During the pregnancy, 36.3% (n=395) of the women were started on insulin therapy and 31.5% (n=337) had excess gestational weight gain at the time of the delivery. Mean gestational age at delivery was 38.5±1.5 weeks. In 729 cases, third-trimester HbA1c was determined and mean third-trimester was HbA1c 5.3±0.4%. Of the 1085 newborn, mean neonatal birth weight was 3188.5±49.5 g, 4.5% (n=49) of these were LGA, 4.8% (n=52) were macrosomic and 19.1% (n=208) had at least one adverse neonatal outcome. On univariate analysis, third-trimester HbA1c presented a 13.6 higher risk of LGA (CI95% 6.1 – 30.5, P<0.001), 4.8 higher risk of fetal macrosomia (CI95% 2.4 – 9.6, P<0.001) and 1.9 higher risk of fetal morbidity (CI95% 1.2 – 3.1, P=0.006). ROC curves showed a cut-off point of third-trimester HbA1c >5.4% for identifying newborns with a greater probability of LGA (Sensitivity: 82.8%; Specificity 72.0%; AUC 0.824; P<0.001); cut-off point of third-trimester HbA1c >5.6% for macrosomia (Sensitivity: 85.1%; Specificity 42.1%; AUC 0.664; P<0.001) and a cut-off point of third-trimester HbA1c >5.3% for fetal morbidity (Sensitivity: 50.4%; Specificity 62.4%; AUC 0.592; P=0.026).
Conclusion: In this study, a cut-off point of third-trimester HbA1c > 5.4% was found to have a good sensitivity and specificity for the identification an increased risk of LGA.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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