The Impact of Preconception Diabetes and Prediabetes on Preterm Birth: Implications for Healthcare Access

Preconception diabetes has long been recognized as a significant risk factor for adverse birth outcomes. However, there is still a limited understanding of the effects of elevated glycemia levels below the clinical cutoffs for diabetes. A recent study by Erin Delker et al. examined the associations between preconception diabetes, prediabetes, and hemoglobin A1c (HbA1c) levels with the risk of preterm birth. Additionally, the study aimed to evaluate whether access to or utilization of healthcare services influenced these associations.

Using data from Add Health, a US prospective cohort study, Delker et al. analyzed information collected from women at different stages of their reproductive journey. Glucose and HbA1c levels were measured during Wave IV (ages 24-32), while reports of preterm birth were obtained during Wave V (ages 32-42). The study included a sample size of 1989 women, among whom 13% experienced preterm birth.

The findings revealed that prior to pregnancy, 6.9% of women had diabetes, 23.7% had prediabetes, and 69.4% were normoglycemic. Compared to the normoglycemic group, women with diabetes had a 2.1-fold increased risk of preterm birth, while women with prediabetes had a 1.3-fold increased risk. Interestingly, the relationship between HbA1c levels and preterm birth demonstrated a nonlinear pattern, with the risk emerging after reaching an HbA1c of 5.7%, which is considered the standard cutoff for prediabetes. Furthermore, the study found that the excess risks of preterm birth associated with elevated HbA1c were four to five times larger among women with unstable healthcare coverage or who relied on the emergency room as their usual source of care.

These findings replicate previous research, underscoring the strong associations between preconception diabetes and preterm birth. Importantly, this study adds to the growing body of evidence by highlighting the increased risk of preterm birth associated with prediabetes. Efforts should be made to enhance healthcare access, ensuring that women have access to regular prenatal care, diabetes screening, and appropriate interventions to manage glycemic levels. Furthermore, interventions should focus on providing comprehensive preconception care, including education and support for women with prediabetes, to mitigate the risk of adverse birth outcomes.

By prioritizing healthcare access and offering appropriate interventions, we can strive towards healthier pregnancies and better outcomes for both mothers and their babies.

Delker E, Ramos GA, Bandoli G, et al. Associations Between Preconception Glycemia and Preterm Birth: The Potential Role of Health Care Access and Utilization. Journal of Women's Health. 2023;32(3):274-282. https://www.liebertpub.com/doi/abs/10.1089/jwh.2022.0256