Peri-Conceptional A1C and Risk of Serious Adverse Pregnancy Outcome in 933 Women With Type 1 Diabetes

  1. Dorte M. Jensen, PHD1,
  2. Lars Korsholm, PHD2,
  3. Per Ovesen, DMSC3,
  4. Henning Beck-Nielsen, DMSC1,
  5. Lars Moelsted-Pedersen, DMSC4,
  6. Jes G. Westergaard, DMSC5,
  7. Margrethe Moeller, MD6 and
  8. Peter Damm, DMSC7
  1. 1Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark;
  2. 2Institute of Statistics and Demographics, University of Southern Denmark, Odense, Denmark;
  3. 3Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark;
  4. 4Department of Obstetrics and Gynecology, Copenhagen County Hospital, University of Copenhagen, Copenhagen, Denmark;
  5. 5Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark;
  6. 6Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark;
  7. 7Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  1. Corresponding author: Dorte M. Jensen, dortemj{at}


OBJECTIVE To study the association between peri-conceptional A1C and serious adverse pregnancy outcome (congenital malformations and perinatal mortality).

RESEARCH DESIGN AND METHODS Prospective data were collected in 933 singleton pregnancies complicated by type 1 diabetes.

RESULTS The risk of serious adverse outcome at different A1C levels was compared with the background population. The risk was significantly higher when peri-conceptional A1C exceeded 6.9%, and the risk tended to increase gradually with increasing A1C. Women with A1C exceeding 10.4% had a very high risk of 16%. Congenital malformation rate increased significantly at A1C above 10.4%, whereas perinatal mortality was increased even at A1C below 6.9%.

CONCLUSIONS These results support recent guidelines of preconceptional A1C levels <7% in women with type 1 diabetes.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received November 15, 2008.
    • Accepted February 26, 2009.
  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.

| Table of Contents

This Article

  1. Diabetes Care vol. 32 no. 6 1046-1048
  1. All Versions of this Article:
    1. dc08-2061v1
    2. 32/6/1046 most recent