Pregnancy Outcomes in Women with Poorly Controlled Pregestational Diabetes MelUtus

Background: The prevalence of pregestational diabetes mellitus (PGDM) in women of reproductive age has surged globally, contributing to increased rates of adverse pregnancy outcomes. Hemoglobin Ale (HbA1c) is a crucial marker for diagnosing and monitoring PGDM, with periconceptional levels influencing the risk of congenital anomalies and complications. Objectives: To evaluate the association between periconceptional HbAlc levels and perinatal complications in pregnant women with poorly controlled PGDM. Methods: We conducted a retrospective analysis of prospectively collected data of pregnancies between 2010 and 2019, HbAlc > 6% at 3 months prior to conception or during the first trimester. Outcomes of periconceptional HbAlc levels were compared. Results: The cohort included 89 women: 49 with HbAlc 6-8%, 29 with HbAlc 8-10%, and 11 with HbAlc > 10%. Higher HbAlc levels were more prevalent in type 1 diabetics and were associated with increased end-organ damage risk. Women with elevated HbAlc levels tended toward unbalanced glucose levels during pregnancy. The cohort exhibited high rates of preterm delivery, hypertensive disorders, cesarean delivery, and neonatal intensive care unit admission. Overall live birth rate was 83%. While a significant correlation was found between HbAlc levels and preterm delivery, no consistent association was observed with other adverse outcomes. Conclusions: Periconceptional glycemic control in PGDM pregnancies is important. Elevated HbAlc levels are associated with increased risks of adverse outcomes. Beyond a certain HbAlc level, risks of complications may not proportionally escalate.