Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study
Associations of maternal A1C and glucose with pregnancy outcomes
- Lynn P. Lowe, PHD1⇓,
- Boyd E. Metzger, MD2,
- Alan R. Dyer, PHD1,
- Julia Lowe, MBCHB3,
- David R. McCance, MD4,
- Terence R.J. Lappin, PHD5,
- Elisabeth R. Trimble, MD6,
- Donald R. Coustan, MD7,
- David R. Hadden, MD4,
- Moshe Hod, MD8,
- Jeremy J.N. Oats, MD9,
- Bengt Persson, MD, PHD10 and
- for the HAPO Study Cooperative Research Group*
- 1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- 2Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- 3Department of Endocrinology, John Hunter Hospital, Newcastle, Australia
- 4Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Northern Ireland, U.K.
- 5Department of Haematology, Queen’s University Belfast, Belfast, Northern Ireland, U.K.
- 6Department of Clinical Biochemistry, Queen’s University Belfast, Belfast, Northern Ireland, U.K.
- 7Division of Maternal Fetal Medicine, Warren Alpert Medical School, Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
- 8Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center–Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Israel
- 9Department of Obstetric Medicine, Mater Misericordiae Mothers’ Hospital–University of Queensland, Brisbane, Australia
- 10Department of Pediatrics, Karolinska Institute, Stockholm, Sweden
- Corresponding author: Lynn P. Lowe, .
OBJECTIVE To compare associations of maternal glucose and A1C with adverse outcomes in the multinational Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and determine, based on those comparisons, if A1C measurement can provide an alternative to an oral glucose tolerance test (OGTT) in pregnant women.
RESEARCH DESIGN AND METHODS Eligible pregnant women underwent a 75-g OGTT at 24–32 weeks’ gestation. A sample for A1C was also collected. Neonatal anthropometrics and cord serum C-peptide were measured. Associations with outcomes were assessed using multiple logistic regression with adjustment for potential confounders.
RESULTS Among 23,316 HAPO Study participants with glucose levels blinded to caregivers, 21,064 had a nonvariant A1C result. The mean ± SD A1C was 4.79 ± 0.40%. Associations were significantly stronger with glucose measures than with A1C for birth weight, sum of skinfolds, and percent body fat >90th percentile and for fasting and 1-h glucose for cord C-peptide (all P < 0.01). For example, in fully adjusted models, odds ratios (ORs) for birth weight >90th percentile for each measure higher by 1 SD were 1.39, 1.45, and 1.38, respectively, for fasting, 1-, and 2-h plasma glucose and 1.15 for A1C. ORs for cord C-peptide >90th percentile were 1.56, 1.45, and 1.35 for glucose, respectively, and 1.32 for A1C. ORs were similar for glucose and A1C for primary cesarean section, preeclampsia, and preterm delivery.
CONCLUSIONS On the basis of associations with adverse outcomes, these findings suggest that A1C measurement is not a useful alternative to an OGTT in pregnant women.
- Received August 31, 2011.
- Accepted December 4, 2011.
- © 2012 by the American Diabetes Association.
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 http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.