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Diabetes Care. 2012 Mar;35(3):574-80. doi: 10.2337/dc11-1687. Epub 2012 Feb 1.

Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes.

Collaborators (152)

Contreras M, Sacks DA, Watson W, Dooley SL, Foderaro M, Niznik C, Bjaloncik J, Catalano PM, Dierker L, Fox S, Gullion L, Johnson C, Lindsay CA, Makovos H, Saker F, Carpenter MW, Hunt J, Somers MH, Amankwah KS, Chan PC, Gherson B, Herer E, Kapur B, Kenshole A, Lawrence G, Matheson K, Mayes L, McLean K, Owen H, Cave C, Fenty G, Gibson E, Hennis A, McIntyre G, Rotchell YE, Spooner C, Thomas HA, Gluck J, Hadden DR, Halliday H, Irwin J, Kearney O, McAnee J, McCance DR, Mousavi M, Traub AI, Cruickshank JK, Derbyshire N, Dry J, Holt AC, Khan F, Lambert C, Maresh M, Prichard F, Townson C, van Haeften TW, van de Hengel AM, Visser GH, Zwart A, Chaovarindr U, Chotigeat U, Deerochanawong C, Panyasiri I, Sanguanpong P, Amichay D, Golan A, Marks K, Mazor M, Ronen J, Wiznitzer A, Chen R, Harel D, Hoter N, Melamed N, Pardo J, Witshner M, Yogev Y, Bowling F, Cowley D, Devenish-Meares P, Liley HG, McArdle A, McIntyre HD, Morrison B, Peacock A, Tremellen A, Tudehope D, Chan KY, Chan NY, Ip LW, Kong SL, Lee YL, Li CY, Ng KF, Ng PC, Rogers MS, Wong KW, Edgar M, Giles W, Gill A, Glover R, Lowe J, Mackenzie F, Siech K, Verma J, Wright A, Cao YH, Chee JJ, Koh A, Tan E, Rajadurai VJ, Wee HY, Yeo GS, Coustan D, Haydon B, Alexander A, Hadden DR, Attias-Raved O, Hod M, Oats JJ, Parry AF, Collard A, Frank AS, Lowe LP, Metzger BE, Thomas A, Case T, Cholod P, Dyer AR, Engelman L, Xiao M, Yang L, Burgess CI, Lappin TR, Nesbitt GS, Sheridan B, Smye M, Trimble ER, Dyer AR, Hod M, Metzger BE, Lowe LP, Oats JJ, Persson B, Trimble ER, Cutter GR, Gabbe SG, Hare JW, Wagenknecht LE, Chen Y, Claman J, King J.

Author information

Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.



To compare associations of maternal glucose and A1C with adverse outcomes in the multinational Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and determine, based on those comparisons, if A1C measurement can provide an alternative to an oral glucose tolerance test (OGTT) in pregnant women.


Eligible pregnant women underwent a 75-g OGTT at 24-32 weeks' gestation. A sample for A1C was also collected. Neonatal anthropometrics and cord serum C-peptide were measured. Associations with outcomes were assessed using multiple logistic regression with adjustment for potential confounders.


Among 23,316 HAPO Study participants with glucose levels blinded to caregivers, 21,064 had a nonvariant A1C result. The mean ± SD A1C was 4.79 ± 0.40%. Associations were significantly stronger with glucose measures than with A1C for birth weight, sum of skinfolds, and percent body fat >90th percentile and for fasting and 1-h glucose for cord C-peptide (all P < 0.01). For example, in fully adjusted models, odds ratios (ORs) for birth weight >90th percentile for each measure higher by 1 SD were 1.39, 1.45, and 1.38, respectively, for fasting, 1-, and 2-h plasma glucose and 1.15 for A1C. ORs for cord C-peptide >90th percentile were 1.56, 1.45, and 1.35 for glucose, respectively, and 1.32 for A1C. ORs were similar for glucose and A1C for primary cesarean section, preeclampsia, and preterm delivery.


On the basis of associations with adverse outcomes, these findings suggest that A1C measurement is not a useful alternative to an OGTT in pregnant women.

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