Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa

Muhammad Imran Nisar, Sayan das, Rasheda Khanam, Javairia Khalid, Swagata Chetia, Tarik Hasan, Shahira Shahid, Msafiri Ladislaus Marijani, Salahuddin Ahmed, Farah Khalid, Said Mohammed Ali, Nabidul Haque Chowdhury, Usma Mehmood, Arup Dutta, Sayedur Rahman, Muhammad Farrukh Qazi, Saikat Deb, Dipak Kumar Mitra, Asra Abeer Usmani, Usha DhingraRubhana Raqib, Alexander Manu, Sachiyo Yoshida, Nicole Minckas, Rajiv Bahl, Abdullah H. Baqui, Sunil Sazawal, Fyezah Jehan

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Background: Hyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa. Methods: We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2–3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders. Results: A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8–6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9–10.6). Conclusion: Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.

Original languageEnglish
Article number66
JournalBMC Pregnancy and Childbirth
Issue number1
Publication statusPublished - Dec 2024


  • Adverse pregnancy outcomes
  • First trimester
  • Gestational Diabetes Mellitus
  • HbA1c
  • LMICs
  • South Asia
  • Sub-Saharan Africa


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