USA: Study on Preconception Diabetes and Preterm Birth

A recent study published in the Journal of Women's Health has shown a strong association between preconception diabetes and preterm birth; prediabetes is also linked with higher risk.

The study of a cohort of US women who gave birth between 2008 and 2018 examined the associations between preconception diabetes, prediabetes, and haemoglobin A1c (HbA1c) levels on the risk of preterm birth. The study also evaluated whether these associations were modified by access to or utilization of healthcare services.

Preconception diabetes is strongly associated with adverse birth outcomes. In the current study, Erin Delker, PhD, from the University of California, San Diego and San Diego State University, and coauthors found that preconception diabetes and prediabetes were associated with increased risk of preterm birth. The investigators reported that the associations between preconception elevated HbA1c and preterm birth were greater among women without stable healthcare coverage.

Key Findings

• The prevalence of preterm birth was 13%.
• Before pregnancy, 6.9% of women had diabetes, 23.7% had prediabetes, and 69.4% were normoglycemic.
• Compared to the normoglycemic group, women with diabetes had 2.1 times the risk of preterm birth, while women with prediabetes had 1.3 times the risk of preterm birth.
• There was a nonlinear relationship between HbA1c and preterm birth such that the risk of preterm birth emerged after HbA1c = 5.7%, a standard cutoff for prediabetes.
• The excess risks of preterm birth associated with elevated HbA1c were four to five times larger among women who reported unstable health care coverage and among women who used the emergency room as usual source of care.

“Our findings, in aggregate with the existing literature, suggest that screening for hyperglycemia before pregnancy is important to identifying women who may experience greater risks of adverse birth outcomes,” state the investigators.

In an accompanying editorial, Amber Healy, DO, from Ohio University Heritage College of Osteopathic Medicine, states that “Recommendations for the diagnosis and treatment of prediabetes in pregnancy are lacking.” Dr. Healy concludes that “Better screening for prediabetes and diabetes preconception and increased access to contraception will prove beneficial in reducing preterm delivery. Engaging both primary care providers and obstetrics/gynecology specialists in these strategies are key to these strategies succeeding.”

Reference

Erin Delker, Gladys A. Ramos, Gretchen Bandoli, D. Yvette LaCoursiere, Karen Ferran, Linda C. Gallo, Eyal Oren, Sheila Gahagan, and Matthew Allison Published Online: 16 Feb 2023

https://doi.org/10.1089/jwh.2022.0256