Glycated Haemoglobin in Last Trimester Pregnancy as a Predictor of Neonatal Hypoglycaemia in Infants of Diabetic Mother.

Abstract

Maternal diabetes in pregnancy has become an emerging health burden. Among various complications neonatal hypoglycaemia is associated with neurodevelopmental sequelae but it is preventable. It will be very helpful if we can predict neonatal hypoglycaemia from maternal last trimester single HbA1c. The aim of the study was to find out whether maternal last trimester single time HbA1c level can predict neonatal hypoglycemia in case of Infant of Diabetic Mother (IDM). It was a hospital based prospective observational study. The study included 70 inborn IDM with maternal last trimester HbA1c attending in Neonatology Department of Mymensingh Medical College Hospital (MMCH), Bangladesh from November 2019 to September 2022. Those IDM babies who had maternal last trimester HbA1c ≥6.0% were selected as Group A and those who had maternal HbA1c <6.0% were selected as Group B. Their clinical evaluation and capillary blood glucose monitoring at ½, 2, 4, 6, 12, 18, 24 hours was done and venous blood glucose was done at 2 and 4 hours of age. Data were collected in a predesigned case record form and finally analyzed by appropriate statistical methods. There was significant difference of mean blood glucose values between two groups at 4, 6 and 18 hours of age. Good agreement was found between venous blood glucose and capillary blood glucose at 2 hours and at 4 hours of age. A moderate negative correlation was observed between maternal HbA1c and blood glucose level of IDMs at 4 hours of age (r = -0.575) and OR is 6.00. We found area under ROC curve for predicting neonatal hypoglycemia was 0.870 and optimal cut-off value was 6.45%, with sensitivity 75.0% and specificity 83.3%. In this study, maternal last trimester single time HbA1c level was found to be a useful tool for predicting neonatal hypoglycaemia.