cc727cda1d0cbb190d10600b3c3bb3bf pmc_10970986.pdf d1089505785e7ae612c2d5498e962318086ebd50 pmc_10970986.pdf 4d2c761cdec28423cb867f9bfaa67d90df8af81a14767fbf3fb22ee11bfb43e5 pmc_10970986.pdf Title: Early HbA1c Levels as a Predictor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis Subject: Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks’ gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53–2.66; RR 1.38, 95% CI 1.15–1.66; RR 1.40, 95% CI 1.07–1.83; and RR 1.67, 95% CI 1.39–2.0, respectively) was shown, with a moderate–high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications. Keywords: glycosylated haemoglobin; hypertension; pregnancy-induced; large for gestational age; macrosomia; pre-eclampsia; pregnancy outcomes Author: Laura Mañé, Humberto Navarro, Juan Pedro-Botet, Juan José Chillarón, Silvia Ballesta, Antonio Payà, Verónica Amador, Juana Antonia Flores-Le Roux and David Benaiges Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Mar 17 10:16:19 2024 CET ModDate: Sun Mar 17 10:29:46 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 574020 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PURWBA+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 AFIAXV+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 KKFQCG+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 KVWVXV+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 SXQPWE+VnURWPalladioL Type 1 Custom yes yes yes 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 48 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 51 0 VYNOLS+CMSY10 Type 1 Builtin yes yes yes 68 0 RHAWTP+EURM10 Type 1 Builtin yes yes yes 79 0 ADJENB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 91 0 ADJEND+PalatinoLinotype TrueType WinAnsi yes yes no 94 0 ADJENF+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 97 0 WAVIOZ+wasy7 Type 1 Builtin yes yes yes 114 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-06-06 02:43:26 CEST RepresentationInformation: pmc_10970986.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-31 06:26:35 CEST Size: 574020 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 445 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Sources and Search Strategy for Identifying Studies Destination: subsection.2.1 Item: Title: Study Selection Destination: subsection.2.2 Item: Title: Data Extraction, Risk of Bias, and Certainty Assessment Destination: subsection.2.3 Item: Title: Data Synthesis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Study Selection Destination: subsection.3.1 Item: Title: Study and Patient Characteristics Destination: subsection.3.2 Item: Title: Quality of the Included Studies Destination: subsection.3.3 Item: Title: Publication Bias Destination: subsection.3.4 Item: Title: Synthesis of Results Destination: subsection.3.5 Item: Title: Subgroup Analysis for Study Design Destination: subsection.3.6 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Early HbA1c Levels as a Predictor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis Author: Laura Mañé, Humberto Navarro, Juan Pedro-Botet, Juan José Chillarón, Silvia Ballesta, Antonio Payà, Verónica Amador, Juana Antonia Flores-Le Roux and David Benaiges Subject: Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks’ gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53 2.66; RR 1.38, 95% CI 1.15 1.66; RR 1.40, 95% CI 1.07 1.83; and RR 1.67, 95% CI 1.39 2.0, respectively) was shown, with a moderate high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications. 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Annotations: Annotation: Subtype: Link Rect: 256, 730, 293, 741 Annotation: Subtype: Link Rect: 520, 706, 557, 718 Checksum: 721611d0 Type: CRC32 Checksum: cc727cda1d0cbb190d10600b3c3bb3bf Type: MD5 Checksum: d1089505785e7ae612c2d5498e962318086ebd50 Type: SHA-1 Checksum: 4d2c761cdec28423cb867f9bfaa67d90df8af81a14767fbf3fb22ee11bfb43e5 Type: SHA-256