Correlation of placental pathology and perinatal outcomes with Hemoglobin A1c in early pregnancy in gravidas with pregestational diabetes mellitus |
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| Affiliation: | 1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA;2. Phoenix Perinatal Associates, Phoenix, AZ, USA;3. Warren Alpert Medical School of Brown University, Providence, RI, USA;4. Division of Research, Women & Infants Hospital of Rhode Island, Providence, RI, USA;5. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medstar Washington Hospital Center, Washington DC, USA;6. Department of Pathology & Laboratory Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA;7. Department of Pathology & Immunology, Washington University School of Medicine, St Louis, MO, USA;1. Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia;2. Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia;3. Department of Molecular Biology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia;1. Istanbul University, Faculty of Science, Department of Molecular Biology and Genetics, Istanbul, Turkey;2. Istanbul Technical University, Faculty of Science, Department of Molecular Biology and Genetics, Istanbul, Turkey;3. Istanbul University, Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul, Turkey;4. Medicus Health Center, Istanbul, Turkey;1. Department of Biology and Medical Genetics, First Faculty of Medicine and General University Hospital, Charles University, Albertov 4, 128 00 Prague, Czech Republic;2. Department of Histology and Embryology, First Faculty of Medicine, Charles University, Albertov 4, 128 00 Prague, Czech Republic;1. Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA;2. Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA;3. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA;4. Department of Medicine, Boston University School of Medicine, One Medical Center Place, Boston, MA 02118, USA;1. Institute of Histology and Embryology, First Faculty of Medicine, Charles University in Prague, Albertov 4, CZ-128 01 Prague 2, Czech Republic;2. Department of Obstetrics and Gynecology of the First Faculty of Medicine and General University Hospital, Apolinářská 18, CZ-128 51 Prague 2, Czech Republic |
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| Abstract: | IntroductionData on the correlation among Hemoglobin A1c (HbA1c), placental pathology, and perinatal outcome in the pregestational diabetic population is severely lacking. We believe that this knowledge will enhance the management of pregnancies complicated by pregestational diabetes. We hypothesize that placental pathology correlates with glycemic control at an early gestational age.MethodsThis is a retrospective cohort study conducted from 2003 to 2011 at a large tertiary care center. Women included had a singleton gestation, preexisting diabetes mellitus, and information about delivery and placental pathology available for review. Placental pathology and perinatal outcomes were compared across three groups of patients with differing HbA1c levels (<6.5%, 6.5–8.4%, and ≥8.5%).Results293 placentas were examined. HbA1c was measured at a mean of 9.5week gestation. Median HbA1c was 7.5%, interquartile range 6.5%–8.9%. 23% of the cohort had HbA1c <6.5%, 41.9% between 6.5% and 8.4%, and 34.8% > 8.5%. BMI varied significantly by group (35.4 vs. 34.4 vs. 32.0 respectively, P = 0.04). Individual placental lesions did not vary with HbA1c levels. The incidence of acute chorioamnionitis differed significantly in the type 1 population and “distal villous hypoplasia” varied in the type 2 population.DiscussionThe results show that HbA1c values in early pregnancy are poor predictors of future placental pathologies. As a result, HbA1c values obtained during early gestation (which reflect the level of glycemic control over an extended period of time) do not correlate with any particular placental pathology, despite reflecting the potential for placental insults secondary to pre-gestational diabetes. |
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| Keywords: | Hemoglobin A1c Placental pathology Pregestational diabetes |
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