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Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017

Luciana Vieira1, Katharine McCarthy2,3, Shelley H Liu3

  • 1Department of Obstetrics and Gynecology, Stamford Health System, Stamford, Connecticut.

American Journal of Perinatology
|August 21, 2023
PubMed

Insights

First-trimester hemoglobin A1c screening in early pregnancy rose significantly but became less targeted to high-risk individuals. This shift coincided with increased gestational diabetes prevalence and less discriminate testing for at-risk populations.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Public Health

Background:

  • Glycated hemoglobin (A1c) is crucial for assessing glycemic control during early pregnancy.
  • Monitoring A1c levels aids in identifying and managing diabetes in pregnant individuals.

Purpose of the Study:

  • To examine trends in first-trimester A1c screening between 2009 and 2017.
  • To identify maternal predictors associated with A1c screening in early pregnancy.
  • To assess the targeting of A1c screening towards high-risk populations over time.

Main Methods:

  • Utilized linked hospital discharge, vital registry data, and the New York City A1C Registry (N=798,312).
  • Analyzed trends in first-trimester A1c screening rates and mean A1c values.
  • Evaluated screening patterns in relation to high-risk factors for gestational diabetes.

Main Results:

  • First-trimester A1c screening increased from 2.3% (2009) to 7.7% (2017).
  • Screening became less targeted to high-risk patients, with decreasing mean A1c values (5.8% to 5.3%).
  • Gestational diabetes prevalence rose, while testing showed reduced discrimination for high-risk groups (e.g., pregestational diabetes, obesity, advanced maternal age, specific ethnicities).

Conclusions:

  • Despite increased screening, A1c testing in early pregnancy became less focused on high-risk individuals.
  • The findings suggest a need to re-evaluate screening strategies to ensure equitable and effective identification of gestational diabetes.

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