Hemoglobin A1c and Early Gestational Diabetes.
Ashley N Battarbee1, Jacqueline H Grant1, Catherine J Vladutiu1
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Journal of Women'S Health (2002)
|July 18, 2020
Summary
Hemoglobin A1c (HbA1c) shows moderate predictive power for early gestational diabetes mellitus (GDM) diagnosis in high-risk pregnancies. A lower HbA1c threshold than in nonpregnant adults may be suitable for early GDM screening.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Clinical Diagnostics
Background:
- Early screening for gestational diabetes mellitus (GDM) is recommended for high-risk pregnancies.
- The optimal diagnostic test for early GDM remains undetermined.
- Evaluating alternative diagnostic markers is crucial for timely GDM management.
Purpose of the Study:
- To assess the diagnostic accuracy of hemoglobin A1c (HbA1c) for early GDM detection.
- To compare HbA1c performance against the established two-step diagnostic approach.
- To determine an optimal HbA1c threshold for identifying early GDM.
Main Methods:
- Retrospective cohort study of 243 women with prior GDM or obesity.
- HbA1c and two-step GDM testing performed before 21 weeks' gestation.
- Receiver operating characteristic curve analysis to evaluate HbA1c diagnostic performance.
Main Results:
- 14 women (5.8%) were diagnosed with early GDM.
- Median HbA1c levels were significantly higher in women with GDM (5.8%) versus those without (5.3%).
- HbA1c demonstrated a moderate area under the curve (AUC) of 0.80 for early GDM diagnosis, with an optimal threshold of 5.6% (64% sensitivity, 84% specificity).
Conclusions:
- Hemoglobin A1c is a moderately predictive marker for early gestational diabetes mellitus.
- The findings support the use of HbA1c as a potential screening tool for early GDM in high-risk pregnancies.
- A diagnostic threshold for HbA1c lower than that used for nonpregnant adults is warranted for early GDM detection.
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