POSTPARTUM LEVELS OF GLYCOSYLATED HEMOGLOBIN IN MOTHERS OF LARGE BABY: A PROSPECTIVE STUDY

Abstract

Background : The delivery of a large baby may indicate that the mother had abnormal glucose tolerance during pregnancy. Glycosylated hemoglobin (HbA1c) concentration might be expected to identify women who had high blood glucose concentration before delivery.
Aim : The aim of this study was to identify retrospectively, gestational diabetes in mothers of large baby and determine the HbA1c cutoff value.
Method: HbA1 was measured in 216 patients within the first three days of postpartum: 100 had large babies: weighing over than 4000g and 113 had normal- sized babies (control group). We exclude mothers who had preterm, hypotrophy baby, stillborn, and diabetic mothers.
Results: The mean concentration of HbA1c was significantly higher in group with large babies than in group control (6.17 %+ 085 vs 5.17+ 0.57 t = 9.78 p < 0.001).
The value of HbA1c = 5.85%, evaluated by ROC curve, was considered as risk factor of macrosomia and then gestational diabetes. 83.5% of mothers with large  babies had HbA1c ? 5.85 vs 7.8% of those with normal sized babies (p < 0.0001). No other significant differences were found between the two groups in other
parameters.
Conclusion: HbA1c level may be of value as a postpartum screen for unrecognized diabetes and may help discriminate between a constitutionally large but otherwise normal newborn and a large infant of a diabetic mother. HbA1c measurements should be obtained in women with large babies, and, if upper than cutoff value found  by curve ROC: 5.85%, maternal and fetal surveillance is recommended.