Abstract
BackgroundWe aimed to assess the utility of HbA1c in the early detection of gestational diabetes (GDM) in the first trimester.MethodsThis prospective study was performed on 700 pregnant women in the perinatology clinic at a tertiary university hospital from March 2018 to March 2020. For all pregnant women, HbA1c and fasting blood glucose (FBG) levels were examined during the first trimester. Then, a GDM screening test was done within 24–28 weeks of pregnancy using a 100 g oral glucose tolerance test (OGTT) as the gold standard test. The GDM diagnosis was made according to the American Diabetes Association (ADA) criteria. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of HbA1c and FBG were calculated using the receiver operating characteristic (ROC) curve.ResultsOf 700 participants, one hundred and fifteen (16.4%) women had GDM. The GDM patients were significantly older and had a higher pre-gestational body mass index and pregnancy weight gain compared to the non-GDM participants. The sensitivity and specificity for ruling out GDM at an HbA1c cut-off value of 4.85% was 92.2 and 32.8%, respectively, with a 95.5% NPV and a 21.2% PPV. Furthermore, sensitivity and specificity for diagnosing GDM at an HbA1c cut-off value of 5.45% was 54.8 and 96.8%, respectively, with a 91.5% NPV and a 76.8% PPV. Using HbA1c could decline OGTT in 40.4% of the pregnant women (28.7% with HbA1c < 4.85 and 11.7% with HbA1c ≥ 5.45%).ConclusionIt seems that the first-trimester HbA1c cannot replace OGTT for the diagnosis of GDM because of its insufficient sensitivity and specificity. However, women with higher first-trimester HbA1c had a high risk for GDM incidence.
Highlights
Gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy is the most prevalent metabolic abnormality during pregnancy and is defined as diabetes first detected at any time during pregnancy [1, 2].The prevalence of GDM is on the rise since the past decades, with an overall frequency of 17.8% [3]
Women with GDM had significantly older age, higher pre-gestational body mass index (BMI), and pregnancy weight gain compared to the non-GDM pregnant women
In pregnant women with GDM, the average HbA1c level was 5.45 ± 0.39% compared to 4.96 ± 0.30% in the women without GDM (P < 0.001)
Summary
Gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy is the most prevalent metabolic abnormality during pregnancy and is defined as diabetes first detected at any time during pregnancy [1, 2]. The prevalence of GDM is on the rise since the past decades, with an overall frequency of 17.8% (range 9.3– 25.5%) [3]. The possible causes for this enhancement are the rise in maternal age and body mass index (BMI), GDM can cause severe obstetrics complications, which affect both mothers and their offspring. A higher risk of preeclampsia and cesarean section rate, fetal growth abnormalities, macrosomia prematurity, neonatal hypoglycemia, as well as maternal and neonatal trauma are some common examples of GDM [4, 5]. We aimed to assess the utility of HbA1c in the early detection of gestational diabetes (GDM) in the first trimester
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
