Obese Nondiabetic Pregnancies and High Maternal Glycated Hemoglobin at Delivery as an Indicator of Offspring and Maternal Postpartum Risks: The Prospective PEACHES Mother-Child Cohort

We investigated whether obese pregnant women negative for gestational diabetes (GDM) still experience dysglycemia, as indicated by high glycated hemoglobin (Hb A1c) at delivery, and whether this impacts offspring and long-term maternal outcomes. Data of 462 mother-child pairs of our prospective Prog...

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Published in:	Clinical chemistry (Baltimore, Md.) Vol. 61; no. 11; pp. 1381 - 1390
Main Authors:	Ensenauer, Regina, Brandlhuber, Lena, Burgmann, Maximiliane, Sobotzki, Christina, Zwafink, Carina, Anzill, Sabine, Holdt, Lesca, Teupser, Daniel, Hasbargen, Uwe, Netz, Heinrich, Roscher, Adelbert A, von Kries, Rüdiger
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-11-2015
Subjects:	Birth Weight Blood Glucose - analysis C-Peptide - blood Child, Preschool Delivery, Obstetric Diabetes, Gestational - blood Diabetes, Gestational - diagnosis Female Fetal Blood - chemistry Glycated Hemoglobin A - analysis Health risks Humans Infant Infant, Newborn Male Metabolic disorders Obesity Obesity - blood Obesity - complications Offspring Postpartum Period Pregnancy Pregnancy Complications - blood Pregnancy Complications - etiology Prospective Studies Womens health
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Summary:	We investigated whether obese pregnant women negative for gestational diabetes (GDM) still experience dysglycemia, as indicated by high glycated hemoglobin (Hb A1c) at delivery, and whether this impacts offspring and long-term maternal outcomes. Data of 462 mother-child pairs of our prospective Programming of Enhanced Adiposity Risk in Childhood - Early Screening (PEACHES) cohort study were analyzed. Of 885 obese and normal-weight pregnancies prospectively enrolled after GDM testing according to the International Association of Diabetes and Pregnancy Study Groups criteria, 462 GDM-negative mothers and their offspring were investigated. We assessed associations of maternal Hb A1c at delivery with large-for-gestational-age (LGA) birth weights, cord-blood C-peptide, and biomarkers of glucose metabolism and inflammation in obese mothers followed for 2.9 years (median) postpartum (n = 42). Cumulative distribution analysis in GDM-negative normal-weight women (n = 155) revealed that 12% had Hb A1c ≥5.7% at delivery (high Hb A1c). Among obese GDM-negative women (n = 307), 31.9% (95% CI, 26.7%-37.4%) equaled or exceeded this cutoff. In obese GDM-negative women with Hb A1c ≥5.7% (n = 98) vs <5.7% (n = 209) at delivery, newborns were more likely to be born LGA [adjusted odds ratio 3.56 (95% CI, 1.64-8.02)], and mean cordblood serum C-peptide was increased by 0.09 ng/mL (95% CI, 0.01-0.17 ng/mL). In the mothers at follow-up, mean postpartum Hb A1c, fasting glucose, high-sensitivity C-reactive protein, and fibrinogen concentrations were higher by 0.3% (95% CI, 0.1%-0.5%), 6.0 mg/dL (95% CI, 2.4-9.5 mg/dL), 6.8 mg/L (95% CI, 1.4-12.3 mg/L), and 74.9 mg/dL (95% CI, 13.6-136.2 mg/dL), respectively. Increased Hb A1c in obese GDM-negative women at delivery indicates gestational dysglycemia, potentially conferring offspring and long-term maternal health risks. These findings should raise awareness as to careful monitoring of obese pregnancies. Measurement of Hb A1c at delivery could help select women who may need closer postpartum health checks.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0009-9147 1530-8561
DOI:	10.1373/clinchem.2015.242206