Associations of first-trimester HbA1c and asprosin with adverse pregnancy outcomes: a prospective cohort study

To examine whether first-trimester HbA1c and asprosin levels are associated with adverse pregnancy outcomes. Singleton pregnant women in northern Thailand were consecutively recruited and underwent first-trimester measurement of maternal HbA1c and asprosin levels. Participants subsequently underwent second-trimester screening for GDM and were followed until delivery. Associations between these biomarkers and pregnancy outcomes, including GDM, insulin requirement, preeclampsia, and preterm birth, were examined using logistic regression. Maternal and neonatal outcomes were further compared between women with and without GDM. Among the 250 women recruited, 90 developed GDM. The mean maternal age, BMI, and gestational age at diagnosis were 31.7 years, 23.5 kg/m², and 25.4 weeks, respectively. First-trimester asprosin levels were not associated with the subsequent development of GDM, insulin requirement, or other adverse maternal and neonatal outcomes. HbA1c emerged as an independent predictor of both subsequent GDM (adjusted OR; 6.53; 95%CI:2.34–18.27) and insulin requirement (adjusted OR; 28.3; 95%CI:3.3-250.4); however, it was not associated with an increased risk of other adverse pregnancy outcomes. Despite the high prevalence of GDM (36%) in this cohort, maternal and neonatal outcomes were comparable between women with and without GDM. However, GDM was associated with an increased risk of preeclampsia, neonatal hypoglycemia, and respiratory distress syndrome. First-trimester HbA1c, but not asprosin, was independently associated with an increased risk of GDM and insulin requirement, while neither biomarker was associated with most adverse pregnancy outcomes. The prevalence of GDM was high in our hospital setting; however, maternal and neonatal outcomes were largely comparable between women without GDM and those with GDM who received management according to standard guidelines.