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Hemoglobin A1c Trajectories During Pregnancy and Adverse Outcomes in Women with Type 2 Diabetes: A Danish National Population-based Cohort Study.

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posted on 2024-05-21, 18:45 authored by Anna S. Koefoed, Sine Knorr, Jens Fuglsang, Magnus Leth-Møller, Adam Hulman, Dorte M. Jensen, Lise Lotte T. Andersen, A. Emilie Rosbach, Peter Damm, Elisabeth R. Mathiesen, Anne Sørensen, Trine T. Christensen, Per Ovesen, Ulla Kampmann

Objective: To identify and characterize groups of pregnant women with type 2 diabetes with distinct hemoglobin A1c (HbA1c) trajectories across gestation and to examine the association with adverse obstetric and perinatal outcomes.

Research Design and Methods: A retrospective Danish national cohort study including all singleton pregnancies in women with type 2 diabetes, giving birth to a liveborn infant, between 2004 and 2019. HbA1c trajectories were identified using latent class linear mixed model analysis. Associations with adverse outcomes were examined with logistic regression models.

Results: In total, 1129 pregnancies were included. Three HbA1c trajectory groups were identified and named according to the glycemic control in early pregnancy (good 59%, moderate 32%, poor 9%). According to the model, all groups attained an estimated HbA1c < 6.5 % (48 mmol/mol) during pregnancy, with no differences between groups in the 3rd trimester. Women with poor glycemic control in early pregnancy had lower odds of having an infant with large-for-gestational-age (LGA) birthweight (adjusted odds ratio (aOR) 0.57, 95% CI 0.40–0.83), and higher odds of having an infant with small-for-gestational-age (SGA) birthweight (aOR 2.49, 95% CI 2.00–3.10) and congenital malformation (CM) (aOR 4.60 95% CI 3.39–6.26) compared to women with good glycemic control. There was no evidence of a difference in odds of preeclampsia, preterm birth and caesarean section between groups.

Conclusions: Women with poor glycemic control in early pregnancy have lower odds of having an infant with LGA birthweight, but higher odds of having an infant with SGA birthweight and CM.


This work was funded by a Novo Nordisk Foundation Steno Collaborative Grant 2018 (grant number #0052373). Steno Diabetes Center Aarhus is partly funded by a donation from the Novo Nordisk Foundation (no. NNF17SA0031230). A.H. is supported by a Data Science Emerging Investigator grant (no. NNF22OC0076725) by the Novo Nordisk Foundation. The funders were not involved in the work reported in this paper, including study design, data collection, data analyses, preparation of manuscripts, or publication decisions.


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