Among women in the US of reproductive age (18–44 years old), diabetes has a prevalence rate of 4.5%. Unfortunately, half of these cases are poorly controlled. It’s estimated that 1%–2% of women enter pregnancy with diabetes, while around 20% of women in this age range have prediabetes. Prediabetes is a metabolic state where blood glucose levels are higher than normal, but not high enough to qualify for a diabetes diagnosis.
Unfortunately, there is not enough documentation to determine the proportion of women entering pregnancy with prediabetes. Having diabetes before pregnancy is associated with negative pregnancy outcomes. Preconception diabetes can increase the odds of preterm birth by 3.5 times, according to a 2017 meta-analysis of 55 studies. On the other hand, there are only a few studies that have looked at the risks associated with preconception prediabetes. Of the few available, two studies found that glucose levels in the prediabetes range were linked with slightly higher birth weight but not with gestation length, while another study found that glucose levels in this range were associated with a small increased risk of preterm birth.
A new study examined the associations between preconception diabetes, prediabetes, and haemoglobin A1c (HbA1c) levels on the risk of preterm birth. The study, which also evaluated whether these associations were modified by access to or utilisation of healthcare services, is published in the peer-reviewed Journal of Women’s Health.
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 both 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.
“Our findings, in aggregate with the existing literature, suggest that screening for hyperglycemia prior to pregnancy is important to identifying women who may experience greater risks of adverse birth outcomes,” explained 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/gynaecology specialists in these strategies is key to these strategies succeeding.”