A comparative study to assess Hba1c levels in antenatal non diabetic women with anemia and without anemia

Background

Glycosylated hemoglobin (HbA1c) has a glucose residue attached to the terminal NH2 group (valine residue) of one or both HbA beta chains. HbA1c levels are not affected by blood glucose levels alone. HbA1c results are affected by several factors, such as anemia, structural hemoglobinopathies and thalassemia syndromes. HbA1c concentrations are affected by conditions that affect erythrocyte turnover. Iron deficiency anemia is the most common form of anemia. The prevalence of anemia among pregnant women in India is above 50 %. Although many forms of anemia are associated with the lowering of HbA1c, iron deficiency has been shown to shift HbA1c slightly upward. Research on this topic has yielded a variety of findings. In some research, there was no association observed between anemia and HbA1c levels; in other investigations, there was a rise or fall in this number. Iron deficiency anemia and HbA1c′s relationship is therefore still unclear. Therefore, this study aims to determine the correlation between Iron deficiency anemia and HbA1c levels among non diabetic pregnant women with anemia.

Methodology

This prospective observational study was conducted among singleton pregnant women attending antenatal clinic OPD in a private tertiary hospital in Chengalpattu, Kanchipuram district. After the complete review of their obstetric record, blood was collected in 5 ml sterile syringes and transferred equally to the two separate test tubes containing ethylene-diamine-tetra acetic acid (EDTA) anticoagulant for determining RBC indices and HbA1c levels. The difference in mean between two independent samples (between Anemia and Non-anemia) was determined using an independent sample t-test, and the difference between two independent proportions was calculated using a z-test. Bivariate Pearson's correlation analysis was used to adjudicate the relationship between red blood cell indices and HbA1c level, and correlation coefficient (r)was calculated, and the p-value of <0.05* was considered statistically significant.

Results

Bivariate Pearson's correlation analysis was done to determine the relationship between HbA1c levels and red blood cells in anemic pregnant women. HbA1c levels negatively correlated with Hemoglobin (r = −0.875, p < 0.01*), PCV (r = −0.732, p =<0.01*) and transferrin saturation (r = 0.224, p < 0.01*) and it was statistically significant. Other indices, such as serum iron concentration and TIBC, demonstrated no correlation with HbA1c level.

Conclusion

This study shows that the reliability of Hba1c in diagnosing diabetes among pregnant women with iron deficiency anemia is misguiding and can be considered after treating the condition. Also, more studies are needed to improve our understanding of this topic.