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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
PubMed

Insights

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.

Keywords:
diagnosisearly gestational diabeteshemoglobin A1cpregnancy

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