(HealthDay)—Women with an elevated hemoglobin A1c preconception may be at higher risk for severe maternal morbidity (SMM) or death during pregnancy or postpartum, according to a study recently published in PLOS Medicine.

Alexander J.F. Davidson, from the University of Toronto, and colleagues evaluated whether an elevated preconception A1c is associated with SMM or maternal death among women with and without known prepregnancy diabetes mellitus (28,075 women without). The analysis included 31,225 women (mean maternal age, 31.1 years) with a hospital live birth or stillbirth from 2007 to 2015 and who had an A1c measured within 90 days before conception.

The researchers found that SMM or death occurred in 682 births (2.2 percent). The relative risk for SMM or death was 1.16 per 0.5 percent increase in A1c and 1.16 in an adjusted analysis. The adjusted relative risk (aRR) remained increased among those with prepregnancy diabetes (1.11) and without prepregnancy diabetes (1.15), as well as when further adjusting for body mass index (1.15) and chronic hypertension and prepregnancy serum creatinine (1.11). Compared with those with an A1c <5.8 percent, the aRR of SMM or death was 1.31 and 2.84 in those with a preconception A1c of 5.8 to 6.4 percent and >6.4 percent, respectively. The aRR of SMM or death was 3.25 among those without previously recognized prepregnancy diabetes and whose A1c was >6.4 percent.

"As there is no current recommendation about A1c testing in nondiabetic pregnant women, especially those with obesity and/or chronic hypertension, our findings may enhance research about the benefits of A1c screening in these women," the authors write.

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