Role of glycosylated hemoglobin of preconception stage in diabetic pregnancy outcome

BACKGROUND: We analysed the relationship between metabolic control paramete rs during the preconception stage and pregnancy outcome in diabetic patient s. PATIENTS AND METHOD: We examined 69 diabetic patients who underwent a preco nception control at the Diabetes and Pregnancy Unit between 1992-1998. At t he end of the preconception care period, 50 women (72.6%) became pregnant. Eight out of them (16%) had an abortion. RESULTS: Women who had an abortion did not differ frome those who had not a n abortion with regard to HbA(1c) levels at the end of the preconception pe riod, age, duration of diabetes, age at diagnosis, anti-thyroid antibodies or microvascular disease. Among 41 single gestations, fetal macrosomia was observed in 36.6% cases, neonatal hypoglycemia in 19.5% and major congenita l malformations in one case. Average level of HbA(1c) was 7.6 +/- 1.3% and 6.5 +/- 0.7 at the beginning and at the end of the preconception period, re spectively (p < 0.001). In the group with macrosomia, average HbA(1c) at th e end of the preconception period was 6.8 +/- 0.66% as opposed to 6.3 +/- 0 .7% for the non-macrosomic group (p < 0.05). A linear correlation was seen between HbA(1c) levels at the end of the preconception period and infant we ight (r = 0,432; p = 0,0141, birth weight ratio (r = 0,450; p = 0,009), and a morbidity score (r = 0,458; p = 0,007). CONCLUSIONS: A better metabolic control during the preconception period may contribute to lessen the risk of fetal macrosomia and neonatal morbidity.