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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 36-39

Glycated hemoglobin in parturient mothers and anthropometry in term neonates: A hospital-based study


1 Independent Practitioner, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences, Puducherry, India
3 Department of Paediatrics, Pondicherry Institute of Medical Sciences, Puducherry, India

Date of Submission06-Mar-2017
Date of Acceptance12-Jun-2017
Date of Web Publication12-Jul-2017

Correspondence Address:
Satish Korah Kuruvila
Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences, Puducherry - 605 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_5_17

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  Abstract 

Context: Gestational diabetes mellitus is the most common medical complication of pregnancy and is considered a major public health problem associated with an increase in perinatal mortality and morbidity rates.
Aims: The aim of this study is to correlate glycated hemoglobin (HbA1c) values of parturient mothers with anthropometry of their newborn babies.
Settings and Design: This was a prospective, observational study.
Subjects and Methods: A total of 1000 patients and their babies who had fulfilled the inclusion criteria and had signed the consent were enrolled in the study. The HbA1c values of parturient mothers with anthropometry of their newborn babies were documented. Correlation analysis of the observed values was of the anthropometry, and the HbA1c values were evaluated.
Statistical Analysis Used: Correlation tests were used for statistical analysis.
Results: A statistical correlation is seen between an HbA1c value >6% and a birth weight more than 3700 g. A similar correlation is seen between a normal HbA1c value and a birth weight between 2500 and 3700 g.
Conclusions: The anthropometric findings could be of value in the management of the newborn babies in the absence of laboratory evidence of deranged sugar values in the antenatal period, especially in the low-resource settings.

Keywords: Glycated hemoglobin, newborn anthropometry, parturient mother


How to cite this article:
Vani J, Kuruvila SK, Krishnan L. Glycated hemoglobin in parturient mothers and anthropometry in term neonates: A hospital-based study. J Curr Res Sci Med 2017;3:36-9

How to cite this URL:
Vani J, Kuruvila SK, Krishnan L. Glycated hemoglobin in parturient mothers and anthropometry in term neonates: A hospital-based study. J Curr Res Sci Med [serial online] 2017 [cited 2020 Nov 30];3:36-9. Available from: https://www.jcrsmed.org/text.asp?2017/3/1/36/210346


  Introduction Top


Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and is considered a major public health problem associated with an increase in perinatal mortality and morbidity rates.[1] Although complications are not always dangerous, they do have potential harm if not managed promptly and correctly. Early continuous prenatal care was observed to be associated with improvements in maternal and perinatal outcomes.[2] Our study was done to observe the correlation between glycated hemoglobin (HbA1c) values with the neonatal anthropometry. The focus is to reveal derangement in the sugar values over a longer period while the fasting and postprandial sugar levels are normal.

Our study was done to observe the correlation between HbA1c values with the neonatal anthropometry. This might help us in identifying the cause for some of the unexpected macrosomic infants. This may also help us in predicting the birth of a big baby and to anticipate the complications and get ourselves ready for the appropriate management.


  Subjects and Methods Top


A prospective study to correlate HbA1c values of parturient mothers with anthropometry of their newborn babies was undertaken. This study was conducted in The Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences (PIMS), Puducherry, a 650-bedded tertiary care center, from August 2012 to August 2014. All parturient mothers with gestational age more than 37 weeks admitted to the labor room in PIMS, Puducherry, during the study and their newborn babies in first hour of life were included in the study. Those who came in preterm labor, had multifetal gestation or presented with an intrauterine fetal demise were not included in the study.

All consecutive parturient who got admitted in the labor room or was taken up for elective or emergency lower segment cesarean section (LSCS) were recruited in our study. The recruited mothers were then screened through the inclusion and exclusion criteria. On fulfilling the inclusion criteria, a patient information sheet was given to the patient detailing the procedure. An informed consent was subsequently obtained from the patient. A total of 1000 patients and their babies who had fulfilled the inclusion criteria and had signed the consent were enrolled in the study. Recruitment was stopped after 1000 patients were enrolled.

HbA1c was determined by the particle-enhanced immunotubometric method on a Semi-Auto Analyser, Merck Microlab 200 using the - HbA1c Diasys reagent. It was based on the principle that antibody which is bound to glucose molecule between 4 and 10 N-terminal amino acids on beta chain of the hemoglobin is measured. The baby was weighed on Phoenix Med Systems Pvt. Ltd., electronic baby weighing scale. The weight was recorded in grams, caution was taken to limit the newborn's exposure to a cold environment, and the baby was never left unattended on the weighing scale. The length of the baby was measured using nonstretchable measuring tape. The baby was made to lie on his/her back, and the head was positioned against a fixed support. The baby's knees were held together, a tape was placed from that fixed support down to the heels, and measurement was taken. The mean of three values was calculated. If the value ends in decimal of 0.5 then it was entered as such. If the measurement ended with <0.5, it was rounded to the previous whole number or if more than 0.5 then it was rounded off to the next whole number. The head circumference of the baby was measured with the same nonstretchable measuring tape. The tape was placed around the largest circumference of the head, beginning above the eyebrows and ears, and continuing around the back of the head. Head circumference was also measured thrice in centimeters, and the mean of all the three values was taken and rounded off like that done for length.

The relevant values entered as above were used to calculate the ponderal index (PI) using the following formula: PI = weight (g) ×100/length (cm).[3]


  Results Top


A total of 1760 parturient who were admitted in the labor room or were taken up for elective or emergency LSCS at our center from July 2012 to August 2014 were recruited in our study. A total of 1225 of these patients were eligible for the study after screening through inclusion and exclusion criteria. The 1000 patients who consented for the study were included for the final analysis.

The patients were divided into three groups depending on the different range of their HbA1c values. This division was based on the WHO 2011 criteria.[3] These patients were accordingly grouped into (a) high range - HbA1c >6%, (b) normal range- HbA1c between 5% and 6%, and (c) low range - HbA1c below 5%.

The newborns of these patients were divided into groups based on the criteria given by the Indian Academy of Paediatrics [4] and Fenton Growth Chart 2013.[5] The newborn groups were classified as (a) high range - birth weight >3700 g (b) normal range - birth weight between 2500 g and 3700 g, and (c) low range - birth weight below 2500 g.

The overall correlation among HbA1c, head circumference [Figure 1], and PI [Figure 2] was calculated, and the results are shown. The overall correlation between HbA1c with newborn anthropometry – birth weight [Figure 3], and length [Figure 4] was done, and the results are depicted as mentioned.
Figure 1: Scatter plot showing the correlation between the head circumference of the newborn and the glycated hemoglobin of the mother before delivery

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Figure 2: Scatter plot showing the correlation between the ponderal index of the newborn and the glycated hemoglobin of the mother prior to delivery

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Figure 3: Scatter plot showing the correlation between the birth weight of the newborn in grams and the glycated hemoglobin of the mother before delivery

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Figure 4: Scatter plot showing the correlation between the length of the newborn in centimeters and the glycated hemoglobin of the mother before delivery

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A statistical correlation is seen between an HbA1c value >6 and a birth weight >3700 g. A similar correlation is seen between a normal HbA1c value and a birth weight between 2500g and 3700 g [Table 1].
Table 1: Correlation between glycated hemoglobin and weight

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Good association is seen between HbA1c and weight according to gestational age of baby born to mother with normal OGTT (r = 13.457, n = 545, P = 0.001) [Table 2].
Table 2: Correlation of glycated hemoglobin with growth according to gestational age in gestational diabetes mellitus and normal oral glucose tolerance test patients

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On dividing into growth according to gestational age, there was an association noted in certain gestational ages, however, overall, there was a strong association between HbA1c and the growth of the baby (r = 12.204, P = 0.002, n = 1000) [Table 3].
Table 3: Correlation of glycated hemoglobin values at different gestational ages

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  Discussion Top


There is an association of maternal glycemic control with the newborn anthropometric values and PI. However, on further dividing the parameters into groups and analyzing, this correlation trend continues to be evident only in certain groups. Good correlation is appreciated between normal Hba1c value between 5% and 6% with newborn birth weight is below 3700 g and HbA1c values more than 6% with newborn weight >3700 g and high PI >3. Although no correlation was observed between the various anthropometric groups of the newborn and HbA1c, the correlation with PI derived from this anthropometric values hold some significance.

On dividing into growth according to gestational age, there was an association noted in certain gestational ages, however, overall, there was a strong association between HbA1c and the growth of the baby (r = 12.204, P = 0.002, n = 1000). Good association is seen especially between HbA1c and weight according to gestational age of baby born to mother with normal OGTT (r = 13.457, n = 545, P = 0.001). This was of major significance as these mothers will be considered normal; no problem will be anticipated and thereby will miss out all the cautious management of a mother with proved abnormal OGTT values. Literature search revealed no similar studies.

This is supported by the American Diabetic Association (ADA) Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of GDM that stringent control of HbA1c values during pregnancy decreases the risk of macrosomia in infants and the other complications of pregnancy and delivery. This can otherwise occur when glycemic control is not carefully managed. ADA recommends HbA1c value of <6% in these patients if it can be achieved without excessive hypoglycemia.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cunningham GF, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC 3rd, Wenstrom KD. Diabetes. In: Seils A, Edmonson KG, Davis K, editors. Williams Obstetrics. 22nd ed. USA: McGraw-Hill Companies, Inc.; 2005. p. 1169-87.  Back to cited text no. 1
    
2.
Bener A, Saleh NM, Al-Hamaq A. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: Global comparisons. Int J Womens Health 2011;3:367-73.  Back to cited text no. 2
[PUBMED]    
3.
World Health Organisation. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus. Abbreviated Report of a WHO Consultation. Geneva: World Health Organisation; 2011.  Back to cited text no. 3
    
4.
Agarwal KN. Growth and development. In: Parthasarthy A, editor. IAP Textbook of Pediatrics. 4th ed. New Delhi: Jaypee Brothers Medical Publishers (Pvt.) Ltd.; 2009. p. 83-96.  Back to cited text no. 4
    
5.
Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013;13:59.  Back to cited text no. 5
[PUBMED]    
6.
Sack DB, Arnold M, Barkis GL, Bruns DE, Horvath AR, Kirkman MS, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011;34:61-99.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
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Subjects and Methods
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