Association of Preoperative HbA1c and Perioperative Glucose Fluctuation With Coagulation Status and Bleeding Outcomes in Diabetic Women Undergoing Cesarean Section: A Retrospective Cohort Study.

Authors

Yuehui Zhang, Lingxiang Chen

Published in

Annali italiani di chirurgia. Volume 97. Issue 7. Pages 1247-1258. Jul 14, 2026.

Abstract

To investigate the associations between preoperative glycated hemoglobin (HbA1c) levels and a three-point perioperative glucose coefficient of variation (CV) with perioperative coagulation status and bleeding outcomes in diabetic women undergoing cesarean section.
This single-center retrospective cohort study included 150 diabetic women who underwent cesarean section at our institution between October 2022 and December 2025. Preoperative HbA1c was used as an indicator of chronic glycemic control. A three-point perioperative glucose CV, derived from the preoperative glucose value, the highest intraoperative glucose value, and the highest postoperative glucose value, was used as an exploratory marker of short-term perioperative glucose fluctuation. The primary outcome was postpartum hemorrhage (PPH), defined as estimated blood loss (EBL) ≥1000 mL. Secondary outcomes included EBL, escalation of hemostatic interventions, transfusion, and perioperative coagulation parameters, including fibrinogen, platelet count, prothrombin time, international normalized ratio, activated partial thromboplastin time, and D-dimer levels.
Among the 150 women, 112 had HbA1c <7.0% and 38 had HbA1c ≥7.0%. Compared with the good glycemic control group, the poor glycemic control group exhibited higher intraoperative and postoperative glucose levels, lower postoperative hemoglobin, platelet count, and fibrinogen levels, and higher international normalized ratio and D-dimer levels. The poor glycemic control group also had higher incidences of perioperative hyperglycemia, PPH, hemostatic escalation, and transfusion. EBL was significantly higher in the poor-control group [630.00 (512.25, 1336.25) mL vs. 492.00 (375.75, 597.50) mL], and the incidence of PPH was also increased (39.47% vs. 3.57%). Univariable logistic regression analysis showed that HbA1c was associated with increased odds of PPH (odds ratio (OR) 4.68, 95% confidence interval (CI) 2.58-8.48), while three-point glucose CV was similarly associated with increased PPH risk (OR 1.19, 95% CI 1.08-1.30). After adjustment for age and body mass index, standardized HbA1c and standardized three-point glucose CV remained associated with PPH (OR 6.86, 95% CI 3.10-15.15; and OR 3.07, 95% CI 1.66-5.67, respectively). Exploratory discrimination analysis demonstrated that the combined model achieved a higher area under the curve than HbA1c alone (0.963 vs. 0.900).
Elevated preoperative HbA1c levels and greater perioperative three-point glucose fluctuation were associated with impaired coagulation profiles and an increased risk of perioperative bleeding in diabetic women undergoing cesarean section. Given that the glucose fluctuation metric was derived from only three perioperative measurements and the number of PPH events was relatively limited, these findings should be considered exploratory rather than definitive evidence of a validated clinical prediction model.

PMID:
42464828
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

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