Obstetric Outcomes & Its Association with First Trimester Glycosylated Haemoglobin In A Teritiary Care Centre In South Kerala

Abstract

Introduction: The prevalence of abnormal glucose metabolism among women in Kerala is increasing steadily, posing significant concerns for maternal and the fetal health. Early maternal hyperglycemia has been associated with adverse obstetric outcomes and long-term metabolic risks in offspring. However, routine screening for Gestational Diabetes Mellitus (GDM) is typically performed later in pregnancy, potentially missing early risk indicators. First-trimester HbA1c has emerged as a promising early marker for identifying women at higher risk.

Aims & Objective: This study aimed to determine the association between first-trimester glycosylated haemoglobin (HbA1c) levels and obstetric outcomes in women delivering at a tertiary care centre in Southern Kerala.

Materials & Methods: A retrospective cohort study was conducted among 664 postpartum women at Pushpagiri Medical College Hospital. Participants were equally divided into two groups based on first-trimester HbA1c levels: <5.9% and ≥5.9%. Data regarding sociodemographic characteristics, clinical history, laboratory investigations, and obstetric outcomes were collected from medical records. Statistical analysis was performed using SPSS version 25, applying chi-square tests for categorical variables, independent t-tests for continuous variables, and calculation of relative risks. A p-value of less than 0.05 was considered statistically significant.

Results: Women with HbA1c ≥5.9% showed significantly higher rates of GDM, gestational hypertension, earlier deliveries, increased likelihood of LSCS, adverse perinatal outcomes, and higher mean birth weight compared to those with lower HbA1c levels. No significant differences were observed in maternal age, pre-pregnancy BMI, or obstetric history.

Conclusion: The elevated first-trimester HbA1c is strongly associated with adverse maternal and neonatal outcomes, supporting its role as an effective early screening tool for identifying high-risk pregnancies.