887 Universal hemoglobin a1c in the early diagnosis of gestational diabetes

Abstract

To compare ACOG’s suggested risk-based early screening protocol with universal hemoglobin A1c screening to identify gestational diabetes before 20 weeks. Retrospective cohort of women who delivered at Crozer Chester Medical Center in 2017. In June 2017, we implemented universal hemoglobin A1c screening for pregnant women. This screening strategy recommended universal hemoglobin A1c, followed by glucose challenge test (GCT) in women whose A1c level was ≥ 5.7%. "Risk-based screening" was based on ACOG's recommendation for early pregnancy screening with 1 hour GCT for overweight/obese women with one additional risk factor (physical inactivity, first-degree relative with DM, high-risk race or ethnicity, prior delivery of infant ≥ 4000g, history of GDM, hypertension, dyslipidemia, PCOS, A1c≥5.7, pre-pregnancy BMI≥40, history of CVD). We compared the incidence of early diagnosis of gestational diabetes between women undergoing "risk-based screening" with women undergoing "universal A1c screening", see figure. 671 women met inclusion criteria. 326 underwent risk-based screening, and 345 underwent universal A1c screening. There was no difference in incidence of women with gestational diabetes diagnosed early in pregnancy using the A1c protocol versus the risk-based protocol (15.15% vs. 16%, p=1), see table. Fewer women screened positive and underwent early glucose screening with the A1c protocol versus risk-based protocol (14.2% vs 28.5%, p <0.001). Women who screened positive with the A1c protocol compared to the risk-based protocol were more likely to develop gestational diabetes (PPV = 32.6% vs PPV = 15%). Universal hemoglobin A1c is an effective screening tool in the early diagnosis of gestational diabetes. There was no difference in diagnosing gestational diabetes before 20 weeks gestation between universal hemoglobin A1c screening and risk-based screening. However, universal A1c screening may be appealing to both providers and patients, as it can be easily included in standard prenatal labs and may lead to fewer early glucose challenge tests.View Large Image Figure ViewerDownload Hi-res image Download (PPT)