Establishing Trimester-Specific Haemoglobin A1c Reference Intervals in Pregnant Women: A retrospective study of healthy South Asian women with normal pregnancy outcomes

Abstract

Objectives: This study aimed to define trimester-specific haemoglobin A1c (HbA1c) reference intervals in healthy, pregnant South Asian women. Methods: This retrospective study was conducted at St. Stephen’s Hospital, Delhi, India, between January 2011 and December 2016. Healthy pregnant women were compared to a control group of healthy non-pregnant women. Pregnant participants had term deliveries of babies with appropriate gestational weights. The HbA1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2) and third (T3) trimester groups. Statistical tests were used to obtain the normal HbA1c reference values and were considered significant when P <0.05. Results: This study included a total of 1,357 healthy pregnant women and a control group of 67 healthy, non-pregnant women. Pregnant women had a median HbA1c of 4.8% (4–5.5%) or 32 mmol/mol (20–39 mmol/mol); non-pregnant women had a median HbA1c of 5.1% (4–5.7%) or 29 mmol/mol (20–37 mmol/mol; P <0.001). The HbA1c levels for the T1, T2 and T3 groups were 4.9% (4.1–5.5%) or 30 mmol/mol (21–37 mmol/mol), 4.8% (4.5–5.3%) or 29 mmol/mol (20–34 mmol/ mol) and 4.8% (3.9–5.6%) or 29 mmol/mol (19–38 mmol/mol), respectively. The HbA1c values were significant when comparing T1 versus T2 (P <0.001), T1 versus T3 (P = 0.002) and T1 versus the non-pregnant group (P = 0.001). However, T2 versus T3 was not significant (P = 0.111). Conclusion: Compared to non-pregnant women, HbA1c levels were lower in pregnant women, despite women in the T2 and T3 groups having a higher body mass index than the women in the T1 and non-pregnant groups. Further research is recommended to understand the factors responsible and validate these findings.

Keywords: Asian; Gestational Diabetes; HbA1c; Pregnancy Trimesters; Reference Values; India.