Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa

Authors

Muhammad Imran Nisar, Aga Khan UniversityFollow
Javairia Khalid, Aga Khan UniversityFollow
Shahira Shahid, Aga Khan UniversityFollow
Farah Khalid, Aga Khan UniversityFollow
Usma Mehmood, Aga Khan UniversityFollow
Muhammad Farrukh Qazi, Aga Khan UniversityFollow
Asra Abeer Usmani, Aga Khan UniversityFollow
Usha Dhingra, Public Health Kinetics, India
Swagata Chetia, Public Health Kinetics, India
Fyezah Jehan, Agha Khan UniversityFollow

Document Type

Article

Department

Paediatrics and Child Health

Abstract

Background: Hyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa.
Methods: We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2-3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders.
Results: A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8-6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9-10.6).
Conclusion: Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.

Comments

Volume, issue and pagination are not provided by the author/publisher.

Publication (Name of Journal)

BMC Pregnancy and Childbirth

DOI

https://doi.org/10.1186/s12884-023-06241-w

Recommended Citation

Nisar, M. I., Khalid, J., Shahid, S., Khalid, F., Mehmood, U., Qazi, M. F., Usmani, A. A., Dhingra, U., Chetia, S., Jehan, F. (2024). Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa. BMC Pregnancy and Childbirth.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/1460