NDLI: 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

Content Provider	Springer Nature : BioMed Central
Author	Nisar, Muhammad Imran das, Sayan Khanam, Rasheda Khalid, Javairia Chetia, Swagata Hasan, Tarik Shahid, Shahira Marijani, Msafiri Ladislaus Ahmed, Salahuddin Khalid, Farah Ali, Said Mohammed Chowdhury, Nabidul Haque Mehmood, Usma Dutta, Arup Rahman, Sayedur Qazi, Muhammad Farrukh Deb, Saikat Mitra, Dipak Kumar Usmani, Asra Abeer Dhingra, Usha Raqib, Rubhana Manu, Alexander Yoshida, Sachiyo Minckas, Nicole Bahl, Rajiv Baqui, Abdullah H. Sazawal, Sunil Jehan, Fyezah
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.
Related Links	https://bmcpregnancychildbirth.biomedcentral.com/counter/pdf/10.1186/s12884-023-06241-w.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	14712393
DOI	10.1186/s12884-023-06241-w
Journal	BMC Pregnancy and Childbirth
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-01-15
Access Restriction	Open
Subject Keyword	Reproductive Medicine Maternal and Child Health Gynecology HbA1c First trimester Gestational Diabetes Mellitus Adverse pregnancy outcomes South Asia Sub-Saharan Africa LMICs
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology
Journal Impact Factor	2.8/2023
5-Year Journal Impact Factor	3.4/2023

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