Correlation of HbA1c levels in third trimester with maternal and perinatal outcome in patients with gestational diabetes mellitus


  • Pavithra R. Department of Obstetrics and Gynaecology, ESIC MC and PGIMSR, Bangalore, Karnataka, India
  • Sreelatha S. Department of Obstetrics and Gynaecology, ESIC MC and PGIMSR, Bangalore, Karnataka, India
  • Pooja P. Department of Obstetrics and Gynaecology, ESIC MC and PGIMSR, Bangalore, Karnataka, India



GDM, Polyhydromnios, Preeclampsia, Hyperbilirubinemia, Hypoglycemia


Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. GDM occurs in 2-22% of pregnancies depending on the diagnostic criteria and the epidemiologic characteristics of the population. Elevation of HBA1c have strong correlation with risks of adverse maternal and neonatal outcomes. Aims and objective were to determine the HbA1c levels and to evaluate the maternal and neonatal outcomes in women with HbA1c <5.8% and >5.8%

Methods: A retrospective study at ESIC-PGIMSR from June 2021 to December 2021.All mothers diagnosed with GDM using IADPSG criteria were included. HbA1c measured during the 2nd or 3rd trimester. Cut offs of HbA1c in 3rd trimester was taken as 5.8 according to Versantvoort et al. Maternal and neonatal outcome were assessed among two groups i.e., HbA1c <5.8% the control group and HbA1c >5.8% the case group. Demographic, maternal, and infant data were entered and statistical analysis done using SPSS software.

Results: Total GDM mothers diagnosed were 152 out of 1454 pregnancies. Incidence is 10.4%. the 38.8% were of 25-30 years age group and 46% were multiparous.48.6% neonates were male and 50.6% were females. Among women with HbA1c >5.8%- Preeclampsia seen in 11 cases (21%), polyhydromnios in 5 cases (11.6%), hypothyroidism in 6 cases (12%) UTI in 1 case (2.3%) and candidiasis in 2 cases (4.6%) while among women with HBA1c <5.8% preeclampsia seen in 20 cases (18.3%), polyhydromnios in 2 cases (1.8%), hypothyroidism in 14 cases (13%) UTI in 2 cases (1.8%) and candidiasis in 4 cases (3.6%). Among women with HbA1c >5.8%-respiratory distress syndrome in 6 babies (13%), hyperbilirubinemia in 9 babies (18.6%), hypoglycemia 2 (4.6%) and hypocalemia in 2 babies (4.6%), 14 babies had normal course (32.5%) while among women with HbA1c 5.8% Among women with HbA1c >5.8%-respiratory distress syndrome in 13 babies (12%), hyperbilirubinemia in 20 babies (18.3%) and hypoglycemia 3 (2.7%).

Conclusions: Optimal control of HbA1c along with lifestyle modification and glycemic control helps to reduce maternal and neonatal complications



Jovanoic L, Savas H, Mehta M, Trujilo A, Pettitt D. Frequent monitoring of A1C during pregnancy as a tool to guide therapy.Diabetes Care. 2011;34.53-4.

Versantvoort ARE, Roosmalen J, Radder JK. Course of HbA1c in non-diabetic pregnancy related to birth weight. Neth J Med. 2013;71:22-5.

Subhash S, Sathyamoorthy M, Prasanna R, Karthikeyan P, Sekar P, Reddy R. HbA1c level in last trimester pregnancy in predicting macrosomia and hypoglycemia in neonate. Int J Contemp Pediatr. 2016;5:1334-8.

Sengupta R, Jesmen S, Banu LA, Habib SH. HbA1C level in 2nd and 3rd trimester with pregnancy outcome in diabetic patients. Birdem Med J. 2012;2:23-8.

Radder JK, Roosmalen J. HbA1c in healthy, pregnant women. Neth J Med. 2005;63:256-9.

Bhat M, Ramesha KN, Sarma SP, Sangeetha Menon SC, Kumar G.Determinants of gestational diabetes mellitus: A case control study in a district tertiary care hospital in South India. Int J Diabetes Dev Ctries 2010;30:91 6.

Ho YR, Wang P, Lu MC, Tseng ST, Yang CP, Yan YH. Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women. Plos One. 2017;15:1-12.

Sreelakshmi PR, Nair S, Soman B, Alex R, Vijayakumar K,Kutty VR. Maternal and neonatal outcomes of gestational diabetes:A retrospective cohort study from Southern India. J Family Med Prim Care 2015;4:395 8.

Fonseca L, Saraiva M, Amado A, Paredes S, Pichel F, Pinto C, Vilaverde J, Dores J. Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes. Arch Endocrinol Metabol. 2021;65:328-35.

Prakash GT, Das AK, Habeebullah S, Bhat V, Shamanna SB. Maternal and neonatal outcome in mothers with gestational diabetes mellitus. Ind J Endocrinol Metabol. 2017;21(6):854.

Kaur N, Goel P, Mehra R, Kaur J. Correlation of HbA1c levels in late pregnancy with maternal and perinatal outcome in patients with gestational diabetes mellitus. Int J Reproduct Contracep Obstetr Gynecol. 2019;8(9):3664-71.






Original Research Articles