The impact of glycosylated hemoglobin and 75-g oral glucose tolerance test glucose levels on birthweight percentile

Doğan, Yasemin; Daryal, Ayşe Seda

doi:10.1590/1806-9282.20240466

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 70 (9) • 2024 • https://doi.org/10.1590/1806-9282.20240466 copy

The impact of glycosylated hemoglobin and 75-g oral glucose tolerance test glucose levels on birthweight percentile

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Our research objective was to validate and contribute further evidence to the studies regarding large for gestational age and birthweight percentile by examining oral glucose tolerance test and glycosylated hemoglobin levels in both healthy women and those with gestational diabetes mellitus.

METHODS:

This retrospective cohort study was conducted at a tertiary care hospital involving 106 women who delivered at gestational week 36 or later between February 2022 and February 2023. Maternal, obstetric, and neonatal data were collected from the participant's medical records. Large for gestational age and non-large for gestational age groups were compared. Correlation analysis was used to determine associations among oral glucose tolerance test, glycosylated hemoglobin levels, and the birthweight percentile.

RESULTS:

Mothers of neonates in the large for gestational age category had higher body mass indexes before pregnancy (p=0.002) and delivery (p=0.003), as well as a higher incidence of gestational diabetes mellitus (p=0.027). Mothers of male large for gestational age infants had higher fasting plasma glucose and glycosylated hemoglobin levels compared to male non-large for gestational age infants (p=0.007 and p=0.004, respectively). There was a weak positive correlation between fasting plasma glucose levels and birthweight percentile in the overall group (r=0.342, p<0.006). Further analysis by gender showed a weak positive correlation between birthweight percentile and fasting plasma glucose and glycosylated hemoglobin values in male newborns (r=0.393, p=0.004 and r=0.373, p=0.006, respectively).

CONCLUSION:

Our study has established a clear association between the birthweight percentile in male infants and the levels of glycosylated hemoglobin and fasting plasma glucose measured during oral glucose tolerance test. It is imperative to devise potential strategies aimed at achieving optimal glycosylated hemoglobin and fasting plasma glucose parameters to effectively reduce the frequency of large for gestational age in male infants.

KEYWORDS:
Large for gestational age infant; Oral glucose tolerance test; Glycated hemoglobin A1c; Birthweight

Maternal/obstetric variables
Maternal age (years)		29 (26–34)
Pre-pregnancy weight (kg)		66.8±13.6
Pre-pregnancy BMI (kg/m²2 Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu MM, Akın MA, Çoban D, Gökoğlu S, et al. Body weight, length and head circumference at birth in a cohort of Turkish newborns. J Clin Res Pediatr Endocrinol. 2012;4(3):132-9. https://doi.org/10.4274/jcrpe.693 https://doi.org/10.4274/jcrpe.693... )		65 (58–73)
Gestational weight gain (kg)		12 (10–16)
Weight before delivery (kg)		77 (71–86)
BMI before delivery (kg/m²2 Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu MM, Akın MA, Çoban D, Gökoğlu S, et al. Body weight, length and head circumference at birth in a cohort of Turkish newborns. J Clin Res Pediatr Endocrinol. 2012;4(3):132-9. https://doi.org/10.4274/jcrpe.693 https://doi.org/10.4274/jcrpe.693... )		29.6 (26.7–33.7)
Parity
	Nulliparous	37 (34.9%)
	Multiparous	69 (65.1%)
Mode of delivery
	Vaginal delivery	30 (28.3%)
	Cesarean delivery	76 (71.7%)
	GDM	23 (21.6%)
	HbA1c (%)	5.2 (4.9–5.3)
	FPG (mg/dL)	82 (76–87)
	1-h OGTT (mg/dL)	132 (114–152)
	2-h OGTT (mg/dL)	109 (93–124)
Neonatal variables
	GA at delivery (weeks)	38 (38–39)
	Birthwieght (g)	3400±458
	Birthweight percentile	63 (31–93)
	1st minute APGAR score	8 (7–8)
	5th minute APGAR score	9 (9–9)
	Umblical cord blood pH	7.33 (7.30–7.36)
	Umblical cord blood glucose (mg/dL)	75 (66–93)
Neonatal gender
	Female	53 (50%)
	Male	53 (50%)

		LGA	Non-LGA	p-value^* * p<0.05 indicates statistical significance.
Maternal age (years)		30 (27–36)	29 (26–33)	0.405^a a Independent-samples Mann-Whitney U test.
Pre-pregnancy weight (kg)		73.8±15.6	63.3±11.1	0.001^b b Independent samples t-test.
Pre-pregnancy BMI (kg/m²2 Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu MM, Akın MA, Çoban D, Gökoğlu S, et al. Body weight, length and head circumference at birth in a cohort of Turkish newborns. J Clin Res Pediatr Endocrinol. 2012;4(3):132-9. https://doi.org/10.4274/jcrpe.693 https://doi.org/10.4274/jcrpe.693... )		28.3±6.1	24.6±4.3	0.002^b b Independent samples t-test.
Gestational weight gain (kg)		12 (10–17)	12 (10–16)	0.637^a a Independent-samples Mann-Whitney U test.
Weight before delivery (kg)		84 (75–97)	75 (67–82)	0.001^a a Independent-samples Mann-Whitney U test.
BMI before delivery (kg/m²2 Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu MM, Akın MA, Çoban D, Gökoğlu S, et al. Body weight, length and head circumference at birth in a cohort of Turkish newborns. J Clin Res Pediatr Endocrinol. 2012;4(3):132-9. https://doi.org/10.4274/jcrpe.693 https://doi.org/10.4274/jcrpe.693... )		33.8 (27.7–37.3)	29.3 (26.7–31.6)	0.003^a a Independent-samples Mann-Whitney U test.
Parity
	Nulliparous	13 (37.1%)	30 (42.3%)	0.769^c c Chi square test. LGA: large for gestational age; BMI: body mass index; GDM: gestational diabetes mellitus; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test; GA: gestational age.
	Multiparous	22 (62.9%)	41 (57.7%)
Mode of delivery
	Vaginal delivery	3 (8.6%)	27 (38.0%)	0.003^c c Chi square test. LGA: large for gestational age; BMI: body mass index; GDM: gestational diabetes mellitus; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test; GA: gestational age.
	Cesarean delivery	32 (91.4%)	44 (62%)
	GDM	12 (34.3%)	11 (15.4%)	0.027^c c Chi square test. LGA: large for gestational age; BMI: body mass index; GDM: gestational diabetes mellitus; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test; GA: gestational age.
	NonGDM	23 (65.7)	60 (84.6%)
	HbA1c (%)	5.2 (5.0–5.5)	5.1 (4.9–5.3)	0.102^a a Independent-samples Mann-Whitney U test.
	FPG (mg/dL)	85 (82–91)	79 (74–86)	<0.001^a a Independent-samples Mann-Whitney U test.
	1-h OGTT (mg/dL)	138 (118–164)	128 (111–145)	0.078^a a Independent-samples Mann-Whitney U test.
	2-h OGTT (mg/dL)	109 (97–128)	110 (92–123)	0.450^a a Independent-samples Mann-Whitney U test.
	GA at delivery (weeks)	37 (37–38)	38 (38–39)	0.007^a a Independent-samples Mann-Whitney U test.
	Birthweight (g)	3877±237	3165±343	<0.001^b b Independent samples t-test.
Amniotic fluid index
	Polyhydramnios	8 (22.9%)	2 (2.9%)	0.003^c c Chi square test. LGA: large for gestational age; BMI: body mass index; GDM: gestational diabetes mellitus; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test; GA: gestational age.
	Normal	27 (77.1%)	67 (97.1%)
Umblical cord blood pH				0.125^a a Independent-samples Mann-Whitney U test.
	Umblical cord blood glucose (mg/dL)	74.3±14.2	81.8±23	0.063^b b Independent samples t-test.
Neonatal gender
	Female	11 (31.4%)	42 (59.2%)	0.013^c c Chi square test. LGA: large for gestational age; BMI: body mass index; GDM: gestational diabetes mellitus; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test; GA: gestational age.
	Male	24 (68.6%)	29 (40.8%)

	Female		p-value^* * p<0.05 indicates statistical significance.	Male		p-value^* * p<0.05 indicates statistical significance.
	LGA	Non-LGA	p-value^* * p<0.05 indicates statistical significance.	LGA	Non-LGA	p-value^* * p<0.05 indicates statistical significance.
HbA1c (%)	5.04±0.50	5.16±0.31	0.480^a a Independent-samples t-test.	5.35±0.44	5.02±0.32	0.004^a a Independent-samples t-test.
FPG (mg/dL)	85 (82–91)	78 (74–86)	0.079^b b Mann-Whitney U test. LGA: large for gestational age; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test.	86 (80–90)	80 (73–84)	0.007^b b Mann-Whitney U test. LGA: large for gestational age; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test.
1-h OGTT (mg/dL)	138 (122–155)	127 (105–144)	0.215^b b Mann-Whitney U test. LGA: large for gestational age; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test.	138 (111–165)	131 (114–146)	0.288^b b Mann-Whitney U test. LGA: large for gestational age; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test.
2-h OGTT (mg/dL)	108 (100–124)	109 (91–123)	0.775^b b Mann-Whitney U test. LGA: large for gestational age; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test.	111 (91–133)	110 (92–121)	0.381^b b Mann-Whitney U test. LGA: large for gestational age; FPG: fasting plasma glucose; OGTT: oral glucose tolerance test.

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[1] *Corresponding author:
perinatolojidr@gmail.com