| Predictive value of glycated hemoglobin levels for large for gestational age infants in women with pregestational diabetes according to body mass index |
Sujin Lee1, Suyeon Park2, Ji-Hee Sung3, Hyun-Joo Seol4, JoonHo Lee5, Seung-Chul Kim6, Sae-Kyoung Choi7, Seung Mi Lee8, Se Jin Lee9, Han-Sung Hwang10, Gi-Su Lee11, Hyun-Soo Park12,13, Soo-Jeong Lee14, Geum Joon Cho4, Subeen Hong1 
, Hyun Sun Ko1
, Diabetes in Pregnancy Study Group of the Korean Society for Maternal Fetal Medicine |
1Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Obstetrics and Gynecology, Inha University Hospital, School of Medicine, Inha University, Incheon, Korea
3Department of Obstetrics and Gynecology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
4Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
5Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
6Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea
7Department of Obstetrics and Gynecology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
8Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
9Department of Obstetrics and Gynecology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
10Department of Obstetrics and Gynecology, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
11Department of Obstetrics and Gynecology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu, Korea
12Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
13Family Medicine Residency, Providence St. Joseph Eureka Hospital, College of Medicine, Eureka, CA, USA
14Department of Obstetrics and Gynecology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea |
Correspondence:
Subeen Hong,
Email: unihsy@catholic.ac.kr
Hyun Sun Ko,
Email: mongkoko@catholic.ac.kr
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Received: 16 April 2026 Revised: 4 June 2026 Accepted: 23 June 2026 |
| Abstract |
Objective
To evaluate whether pre-pregnancy body mass index (BMI) modifies the predictive ability of glycosylated hemoglobin (HbA1c) for large for gestational age (LGA) infants in women with pregestational diabetes.
Methods
This multicenter retrospective cohort study included 402 women with pregestational diabetes from 17 University Hospitals in South Korea. Pregestational diabetes included early-diagnosed gestational diabetes, type 1 diabetes, and type 2 diabetes. Participants were categorized by pre-pregnancy BMI (<25 vs. ≥25 kg/m2). The primary outcome was LGA birth. Logistic regression was used to assess the association between trimester-specific HbA1c levels and LGA in each BMI group. Receiver operating characteristic (ROC) curve analysis evaluated predictive performance.
Results
Among 402 women, 183 (45.5%) had a BMI <25 kg/m2 and 219 (54.5%) had a BMI ≥25 kg/m2. In the BMI <25 kg/m2 group, higher HbA1c levels in all trimesters were significantly associated with an increased risk of LGA, with the strongest association in the third trimester (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.46-3.58). In women with BMI ≥25 kg/m2, only third-trimester HbA1c was significantly associated with LGA (OR, 1.455; 95% CI, 1.069-1.981). ROC analysis showed moderate discrimination for LGA prediction in women with BMI <25 kg/m2 (area under the curve [AUC], 0.70-0.82), but poor discrimination in those with BMI ≥25 kg/m2 (all AUCs ≤0.65).
Conclusion
The predictive utility of HbA1c for LGA differed according to pre-pregnancy BMI and was greater in women with BMI <25 kg/m2 than in those with BMI ≥25 kg/m2. |
| Keywords:
Infant; Large for gestational age; Body mass index; Pregnancy; Diabetes mellitus |
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