Association of excessive gestational weight gain and the glycated hemoglobin level at term with adverse pregnancy outcomes in patients with gestational diabetes mellitus

Objective: This study aimed to determine the association of excessive gestational weight gain (GWG) and the glycated hemoglobin (HbA1c) level with adverse pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods: The mode of delivery, Apgar score, gestational age at delivery, and birth weight were measured immediately after delivery. Neonates were categorized as small-for-gestational age, appropriate-for-gestational age, or large-for-gestational age (LGA). The rates of cesarean section, instrumental delivery, perineal tear, and postpartum hemorrhage were noted. Neonatal complications were observed. The association of excessive GWG and the HbA1c level with adverse pregnancy outcomes was determined, and receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the HbA1c level for predicting LGA. Results: An HbA1c value of ≥5.7% was associated with adverse outcomes, such as lower segment cesarean section (LSCS) / instrumental delivery and LGA. The HbA1c cutoff value of ≥5.7% demonstrated a maximum sensitivity and specificity for predicting LGA and had an area under the ROC curve of 0.722. Excessive GWG was associated with adverse outcomes, such as LGA, neonatal intensive care unit admission, jaundice, hypoglycemia, respiratory distress, and perineal tear. Conclusions: Excessive GWG is associated with adverse neonatal outcomes. The cutoff value of HbA1c for predicting LGA was ≥5.7%. An elevated HbA1c level (≥5.7%) was associated with a higher rate of caesarean section/instrumental delivery.