Nav: Home

Glucose levels linked to maternal mortality even in non-diabetic women

May 22, 2020

An elevated pre-pregnancy hemoglobin A1c--which measures average blood glucose concentration--is associated with a higher risk of adverse pregnancy outcomes even in women without known diabetes, according to a new study published this week in PLOS Medicine by Joel Ray of ICES and the University of Toronto, Canada, and colleagues.

Diabetes mellitus and obesity are both associated with adverse pregnancy outcomes but the relationship between pre-pregnancy A1c and severe maternal morbidity or maternal mortality is unknown. In the new study, researchers used data from the Canadian province of Ontario spanning 2007 through 2015. The study included data on 31,225 women aged 16 through 50 years with a hospital live birth or stillbirth and who had an A1c measured within 90 days before conception. 28,075 of the women (90%) did not have a known diagnosis of diabetes mellitus.

Overall, the risk of severe maternal morbidity (SMM) or death from 23 weeks gestation to 6 weeks postpartum was 2.2%. For each 0.5% absolute increase in A1c, the relative risk of SMM or death was 1.16 (95% CI 1.14-1.19, p<0.001) after adjusting for maternal age, multifetal pregnancy, world region of origin, and tobacco/drug dependence. Compared to those with a healthy preconception A1c (below 5.8%), the adjusted relative risk of SMM or death was 1.31 (95% CI 1.06-1.62, p=0.01) in those with a preconception A1c of 5.8-6.4% and 2.84 (95% CI 2.31-3.49, p<0.001) in those with a preconception A1c greater than 6.4%. Among women without a diagnosis of diabetes who had an A1c over 6.4%, the adjusted relative risk was 3.25 (95% CI 1.76-6.00, p<0.001).

The authors note that most women do not undergo A1c testing, which may have led to selection bias among the cohort. Additionally, pre-pregnancy body mass index was unknown for 77% of the participants. Therefore, the potential interaction between BMI, A1c and risk of SMM should be investigated further. Still, these findings have implications for pre-pregnancy health screening.

"Given its convenient and widespread use, A1c testing may identify those women with preexisting diabetes mellitus at risk of severe maternal mortality, in a manner similar to its current use in recognizing those at higher risk of fetal anomalies, preterm birth and pre-eclampsia," the authors say. "As there is no current recommendation about A1c testing in nondiabetic pregnant women, especially those with obesity and/or chronic hypertension, our findings may enhance research about the benefits of A1c screening in these women."
-end-
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003104

Funding: This work was funded by a Catalyst Grant: Understanding Disease Prevention and Risk Factor Modification, from the Canadian Institutes of Health Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Davidson AJF, Park AL, Berger H, Aoyama K, Harel Z, Cook JL, et al. (2020) Risk of severe maternal morbidity or death in relation to elevated hemoglobin A1c preconception, and in early pregnancy: A population-based cohort study. PLoS Med 17(5): e1003104. https://doi.org/10.1371/journal.pmed.1003104

Author Affiliations: ICES and the University of Toronto, Toronto, Ontario, Canada.

PLOS

Related Diabetes Articles:

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.
Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.
Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).
Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.
People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.
Diabetes, but not diabetes drug, linked to poor pregnancy outcomes
New research indicates that pregnant women with pre-gestational diabetes who take metformin are at a higher risk for adverse pregnancy outcomes -- such as major birth defects and pregnancy loss -- than the general population, but their increased risk is not due to metformin but diabetes.
New oral diabetes drug shows promise in phase 3 trial for patients with type 1 diabetes
A University of Colorado Anschutz Medical Campus study finds sotagliflozin helps control glucose and reduces the need for insulin in patients with type 1 diabetes.
Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin
Two studies in the Jan. 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.
Complications of type 2 diabetes affect quality of life, care can lead to diabetes burnout
T2D Lifestyle, a national survey by Health Union of more than 400 individuals experiencing type 2 diabetes (T2D), reveals that patients not only struggle with commonly understood complications, but also numerous lesser known ones that people do not associate with diabetes.
A better way to predict diabetes
An international team of researchers has discovered a simple, accurate new way to predict which women with gestational diabetes will develop type 2 diabetes after delivery.
More Diabetes News and Diabetes Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Our Relationship With Water
We need water to live. But with rising seas and so many lacking clean water – water is in crisis and so are we. This hour, TED speakers explore ideas around restoring our relationship with water. Guests on the show include legal scholar Kelsey Leonard, artist LaToya Ruby Frazier, and community organizer Colette Pichon Battle.
Now Playing: Science for the People

#568 Poker Face Psychology
Anyone who's seen pop culture depictions of poker might think statistics and math is the only way to get ahead. But no, there's psychology too. Author Maria Konnikova took her Ph.D. in psychology to the poker table, and turned out to be good. So good, she went pro in poker, and learned all about her own biases on the way. We're talking about her new book "The Biggest Bluff: How I Learned to Pay Attention, Master Myself, and Win".
Now Playing: Radiolab

Uncounted
First things first: our very own Latif Nasser has an exciting new show on Netflix. He talks to Jad about the hidden forces of the world that connect us all. Then, with an eye on the upcoming election, we take a look back: at two pieces from More Perfect Season 3 about Constitutional amendments that determine who gets to vote. Former Radiolab producer Julia Longoria takes us to Washington, D.C. The capital is at the heart of our democracy, but it's not a state, and it wasn't until the 23rd Amendment that its people got the right to vote for president. But that still left DC without full representation in Congress; D.C. sends a "non-voting delegate" to the House. Julia profiles that delegate, Congresswoman Eleanor Holmes Norton, and her unique approach to fighting for power in a virtually powerless role. Second, Radiolab producer Sarah Qari looks at a current fight to lower the US voting age to 16 that harkens back to the fight for the 26th Amendment in the 1960s. Eighteen-year-olds at the time argued that if they were old enough to be drafted to fight in the War, they were old enough to have a voice in our democracy. But what about today, when even younger Americans are finding themselves at the center of national political debates? Does it mean we should lower the voting age even further? This episode was reported and produced by Julia Longoria and Sarah Qari. Check out Latif Nasser's new Netflix show Connected here. Support Radiolab today at Radiolab.org/donate.