Glycosylated hemoglobin concentration in early gestation associated with neonatal outcome.

Previous studies have indicated an association of fetal macrosomia with mild degrees of glucose intolerance in late pregnancy. To determine whether glycosylated hemoglobin concentration in early gestation was related to fetal outcome, 48 pregnant women with normal glucose tolerance and 21 women with gestational diabetes were studied. Glycosylated hemoglobin concentration was determined by a specific aminophenylboronic acid assay, and mean glycosylated hemoglobin concentration was calculated from two or three determinations before 17 weeks' gestation. The incidence of infants large for gestational age was 10% in nondiabetic women with glycosylated hemoglobin concentration of less than 6.0%. With glycosylated hemoglobin concentration of 6.0% to 6.9%, the incidence of infants who were large for gestational age was increased in both nondiabetic women (75%, p less than 0.01) and diabetic women (40%, p less than 0.01). With glycosylated hemoglobin concentration of greater than 7.0%, 36% of infants of diabetic women were large for gestational age. The incidence of hyperbilirubinemia was 2.5% in the infants of nondiabetic women with glycosylated hemoglobin concentration of 6.0%. With glycosylated hemoglobin concentration of 6.0% to 6.9%, hyperbilirubinemia was increased in both the infants of nondiabetic women (38%, p less than 0.01) and diabetic women (30%, p less than 0.01). With glycosylated hemoglobin concentration of greater than 7.0%, hyperbilirubinemia was present in 27% of infants of diabetic mothers. The current study suggests that glycosylated hemoglobin concentration elevation in early gestation is associated with perinatal morbidity.