SAT132 Isolated Elevated Hemoglobin A1c At Early Diagnosis Of Gestational Diabetes Does Not Predict Need For Hypoglycemic Agents
Authors: Markovic Emily S , Rios Jeanette , Scarpelli-Shchur Sophia , Kaplowitz Elianna , Strauss Tirtza S , Brustman Lois 
Published: October 2023

Disclosure: E.S. Markovic: None. J. Rios: None. S. Scarpelli-Shchur: None. E. Kaplowitz: None. T.S. Strauss: None. L. Brustman: None.

Introduction: ACOG recommends universal screening for gestational diabetes (GDM) at 24 - 28 weeks, as well as screening at the initiation of prenatal care for patients with risk factors. While HbA1c ≥5.7% signifies impaired glucose regulation, data is limited regarding its prognostic utility in patients with early diagnosis of GDM (&lt;24 weeks). We hypothesized that HbA1c &gt;5.7% at diagnosis predicts worse disease as measured by need for hypoglycemic medication. We also compared neonatal outcomes between patients HbA1c &gt; and &lt; 5.7%. Methods: An IRB approved retrospective cohort study from 2016 - 2021 of patients in our Diabetes in Pregnancy Program diagnosed with GDM &lt;24 weeks by Carpenter-Coustan criteria or fingerstick paneling. We compared those with HbA1c &gt;5.7% to those with HbA1c &lt;5.7% with regard to demographics, need for hypoglycemic medication in pregnancy and neonatal outcomes including birth weight, Apgar scores, hypoglycemia, respiratory distress, jaundice, stillbirth and NICU admission. Results: 113 out of 1,520 patients had early onset GDM with HbA1c drawn at time of diagnosis. HbA1c range 4.5 - 7.5% (median 5.5%). Gestational age at diagnosis range 6.4 - 23 weeks (median 15.6 weeks). 72 (64%) had a HbA1c &lt;5.7% while 41 (36%) had a HbA1c ≥5.7%. Larger BMI (p&lt;0.0001), higher fasting GTT (p&lt;0.0001), larger number of abnormal GTT values (p=0.009), Hispanic ethnicity (p=0.003) or Black race (p=0.004), and hyperlipidemia (p=0.016) were significantly associated with HbA1c &gt;5.7%.

A greater proportion of patients with HbA1c ≥5.7% required hypoglycemic medication [37 (90%) vs. 51 (71%), p= 0.032]. Patients with HbA1c &gt;5.7% were 3.9 times more likely to require hypoglycemic agents compared to patients with HbA1c &lt;5.7% (p=0.042). The odds of receiving medication were 8.5 times greater for each percent increase in HbA1c (p=0.004). After adjusting for confounders, HbA1c ≥5.7% at early GDM diagnosis was not significantly associated with increased likelihood of needing hypoglycemic agents (OR=3.4; p=0.304). Only fasting GTT was associated with needing hypoglycemic agents (OR=1.2; 95% CI: 1.0, 1.3; p=0.023). HbA1c &gt;5.7% was associated with lower Apgar score at 1 minute (p=0.039) and earlier gestational age at delivery (p=0.009) but these were not significant after adjusting for confounders. Conclusion: The premise of our study was that HbA1c &gt;5.7% in early diagnosed GDM would be associated with impaired glucose tolerance and therefore more significant disease. Counterintuitively, our data do not suggest this. An isolated HbA1c &gt;5.7% was not predictive of the need for hypoglycemic agents or adverse neonatal outcomes. Future directions should include large prospective studies to clarify if HbA1c &gt;5.7% is associated with more severe disease, adverse neonatal outcomes, and the development of type 2 diabetes.

Presentation: Saturday, June 17, 2023