학술논문
Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa.
Document Type
Academic Journal
Author
Nisar MI; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; das S; Center for Public Health Kinetics, New Delhi, India.; Khanam R; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, Baltimore, USA.; Khalid J; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; Chetia S; Center for Public Health Kinetics, New Delhi, India.; Hasan T; Projahnmo Research Foundation, Dhaka, Bangladesh.; Shahid S; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; Marijani ML; Ministry of Health, Zanzibar, Tanzania.; Ahmed S; Projahnmo Research Foundation, Dhaka, Bangladesh.; Khalid F; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; Ali SM; Public Health Laboratory-IDC, Pemba, Tanzania.; Chowdhury NH; Projahnmo Research Foundation, Dhaka, Bangladesh.; Mehmood U; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; Dutta A; Center for Public Health Kinetics, New Delhi, India.; Rahman S; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.; Qazi MF; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; Deb S; Center for Public Health Kinetics, New Delhi, India.; Public Health Laboratory-IDC, Pemba, Tanzania.; Mitra DK; Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh.; Usmani AA; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.; Dhingra U; Center for Public Health Kinetics, New Delhi, India.; Raqib R; International Center for Diarrheal Disease Research, Dhaka, Bangladesh.; Manu A; London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK.; Yoshida S; Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland. yoshidas@who.int.; Minckas N; Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland.; Bahl R; Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland.; Baqui AH; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, Baltimore, USA.; Sazawal S; Center for Public Health Kinetics, New Delhi, India.; Jehan F; Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. fyezah.jehan@aku.edu.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Hyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa.
Methods: We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2-3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders.
Results: A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8-6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9-10.6).
Conclusion: Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.
(© 2024. The Author(s).)
Methods: We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2-3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders.
Results: A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8-6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9-10.6).
Conclusion: Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.
(© 2024. The Author(s).)