Associations between glycosylated hemoglobin level at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan: The Japan Environment and Children's Study (JECS)

Noriyuki Iwama; Takashi Sugiyama; Hirohito Metoki; Masatoshi Saito; Tetsuro Hoshiai; Zen Watanabe; Kosuke Tanaka; Satomi Sasaki; Kasumi Sakurai; Mami Ishikuro; Taku Obara; Nozomi Tatsuta; Hidekazu Nishigori; Shin-Ichi Kuriyama; Takahiro Arima; Kunihiko Nakai; Nobuo Yaegashi; Japan Environment and Children's Study Group

doi:10.1016/j.diabres.2020.108377

Associations between glycosylated hemoglobin level at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan: The Japan Environment and Children's Study (JECS)

Diabetes Res Clin Pract. 2020 Nov:169:108377. doi: 10.1016/j.diabres.2020.108377. Epub 2020 Aug 21.

Authors

Noriyuki Iwama¹, Takashi Sugiyama², Hirohito Metoki³, Masatoshi Saito⁴, Tetsuro Hoshiai⁵, Zen Watanabe⁶, Kosuke Tanaka⁷, Satomi Sasaki⁶, Kasumi Sakurai⁸, Mami Ishikuro⁹, Taku Obara¹⁰, Nozomi Tatsuta¹¹, Hidekazu Nishigori¹², Shin-Ichi Kuriyama¹³, Takahiro Arima¹⁴, Kunihiko Nakai¹⁵, Nobuo Yaegashi¹⁶; Japan Environment and Children's Study Group

Affiliations

¹ Center for Perinatal Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan; Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan. Electronic address: noriyuki.iwama@med.tohoku.ac.jp.
² Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan. Electronic address: sugiyama@m.ehime-u.ac.jp.
³ Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Division of Public Health, Hygiene and Epidemiology, Tohoku Medical Pharmaceutical University, 1-15-1 Fukumuro, Sendai 983-8536, Miyagi, Japan. Electronic address: hmetoki@tohoku-mpu.ac.jp.
⁴ Center for Perinatal Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan.
⁵ Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan. Electronic address: t-hoshiai@umin.org.
⁶ Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan.
⁷ Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan. Electronic address: ko-tanaka@med.tohoku.ac.jp.
⁸ Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan. Electronic address: kasumi-s@med.tohoku.ac.jp.
⁹ Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan. Electronic address: m_ishikuro@med.tohoku.ac.jp.
¹⁰ Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan; Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan. Electronic address: obara-t@hosp.tohoku.ac.jp.
¹¹ Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan. Electronic address: nozomi@med.tohoku.ac.jp.
¹² Fukushima Medical Center for Children and Women, Fukushima Medical University, 1, Hikarigaoka, Fukushima 960-1295, Fukushima, Japan. Electronic address: nishigori@med.tohoku.ac.jp.
¹³ Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan; International Research Institute of Disaster Science, Tohoku University, 468-1, Aramaki, Sendai 980-8572, Miyagi, Japan. Electronic address: kuriyama@med.tohoku.ac.jp.
¹⁴ Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan. Electronic address: tarima@med.tohoku.ac.jp.
¹⁵ Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan. Electronic address: nakaik@med.tohoku.ac.jp.
¹⁶ Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan. Electronic address: yaegashi@med.tohoku.ac.jp.

PMID: 32828835
DOI: 10.1016/j.diabres.2020.108377

Abstract

Aims: To investigate the associations between glycosylated hemoglobin (HbA1c) levels at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan.

Methods: This was a prospective nationwide birth cohort study of 77,526 subjects with an HbA1c level of <6.5% (<48 mmol/mol) at less than 24 weeks of gestation. Associations of HbA1c level with adverse pregnancy outcomes were evaluated using multivariate analyses.

Results: The adjusted odds ratios per 1% (11 mmol/mol) increase in HbA1c level were 1.77 (95% confidence interval [CI]: 1.48-2.12) for hypertensive disorders of pregnancy; 1.78 (95% CI: 1.12-2.83) for placental abruption; 1.30 (95% CI: 1.12-1.50) for preterm birth; 2.11 (95% CI: 1.41-3.16) for very preterm birth; 1.49 (95% CI: 1.33-1.68) for low birth weight infants; 1.95 (95% CI: 1.42-2.70) for macrosomia; 1.23 (95% CI: 1.09-1.39) for small for gestational age; 1.15 (95% CI: 1.04-1.28) for large for gestational age; and 1.29 (95% CI: 1.20-1.39) for the composite adverse pregnancy outcome.

Conclusions: The higher the HbA1c level, the higher the risk of adverse pregnancy outcomes in Japan. Further studies will be needed to determine prenatal management based on the HbA1c level in pregnant women with HbA1c <6.5% (<48 mmol/mol) at less than 24 weeks of gestation.

Keywords: HbA1c; Hypertensive disorders of pregnancy; Infant birth weight; Placental abruption; Preterm birth.

MeSH terms

Adult
Cohort Studies
Diabetes, Gestational / diagnosis*
Diabetes, Gestational / pathology
Female
Glycated Hemoglobin / analysis
Glycated Hemoglobin / metabolism*
Humans
Infant, Newborn
Japan
Pregnancy
Pregnancy Complications / etiology*
Pregnancy Outcome
Prospective Studies

Substances

Glycated Hemoglobin A