The utility of HbA1c combined with haematocrit for early screening of gestational diabetes mellitus

Kui Wu,Qingying Zhang,Ziwen Ma,Junxiu Liu,Haidong Cheng,Tingting Li,Yan Cheng

doi:10.1186/s13098-018-0314-9

Kui Wu, Qingying Zhang + Show 5 more

Open Access

https://doi.org/10.1186/s13098-018-0314-9

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Abstract

AimsTo evaluate the utility of glycated haemoglobin A1c (HbA1c) alone and in combination with haematocrit (HCT) for screening gestational diabetes mellitus (GDM) between 12–16 gestational weeks.MethodsThis prospective study was carried out in the Obstetrics and Gynaecology Hospital of Fudan University from November 2014 to February 2015. In total, 690 pregnant women between 20 and 35 years old were included in this study. All subjects received a routine blood examination for HbA1c and HCT at 12–16 gestational weeks (gw) and a 75-g oral glucose tolerance test at 24–28 gw. Threshold values for the diagnosis of GDM were a plasma glucose concentration of 5.1 mmol/L after fasting, 10.0 mmol/L at 60 min, and 8.5 mmol/L at 120 min. Receiver operating characteristic curves were used to evaluate the diagnostic performance of HbA1c with or without HCT.ResultsOne hundred seven women were diagnosis with GDM at 24–28 gw. An HbA1c cutoff value < 4.55% at 12–16 gw showed adequate sensitivity to exclude GDM (85.0%) but low specificity (17.3%), while an HbA1c cutoff value ≥ 5.25% presented adequate specificity (96.6%) but low sensitivity (13.3%) in diagnosing GDM. The area under the receiver operating characteristic curve for HbA1c (12–16 gw) detection of GDM was 0.563 (95% confidence interval [CI], 0.50–0.625). When combined HbA1c with HCT ( > 38.8%) for the screening of GDM, the area under the receiver operating characteristic curve was 0.604 (95% [CI] 0.509, 0.701).ConclusionsWhether the adoption of HbA1c as a screening test for GDM would benefit pregnant women remains to be determined. However, combining HbA1c with HCT for the screening of GDM may be a useful tool to predict GDM.

Highlights

Gestational diabetes mellitus (GDM) is a pregnancy complication that is linked with insulin resistance and increases the risk of macrosomia and perinatal morbidity and mortality for the foetus, while presaging a long-term risk of developing type 2 diabetes for the mother [1,2,3]
107 (15.5%) were diagnosed with GDM using oral glucose tolerance test (OGTT) according to the IADPSG criteria
The area under the receiver operating characteristic (ROC) curve (AUC) of haemoglobin A1c (HbA1c) to detect GDM was 0.563 [95% CI 0.50–0.625, P 0.038], indicating that HbA1c alone is a poor test for predicting GDM

Summary

Introduction

Gestational diabetes mellitus (GDM) is a pregnancy complication that is linked with insulin resistance and increases the risk of macrosomia and perinatal morbidity and mortality for the foetus, while presaging a long-term risk of developing type 2 diabetes for the mother [1,2,3]. The diagnosis of GDM is performed with a 75-g oral glucose tolerance test (OGTT) at 24–28 weeks gestation for all pregnant women [4]. The mean plasma glucose over the erythrocyte life span is correlated with a degree of glycosylation. It is a single, nonfasting blood test and reflects the glucose levels over the previous 4–8 weeks. HbA1c measurement has become an attractive option, as it is added to the routine early pregnancy laboratory tests (first antenatal blood draws) in the non-fasting patient. HbA1c levels have been proposed as a diagnostic tool for identifying patients with undiagnosed diabetes or a risk of developing diabetes [8]. There are no recommendations available for the use of HbA1c as a diagnostic tool for GDM [10,11,12]

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