First Trimester Hemoglobin A1c Prediction of Gestational Diabetes

Osmundson, Sarah S.; Zhao, Beinan; Kunz, Liza; Wang, Elsie; Popat, Rita A.; Nimbal, Vani; Palaniappan, Latha

doi:10.1055/s-0036-1581055

Cited by 43 publications

(23 citation statements)

References 15 publications

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“…This optimal cutpoint maximizes the effectiveness of the test, but may not be ideal for the sole purpose of GDM diagnosis given that we have existing diagnostics based on the OGTT and the purpose of measuring HbA 1c would only be an earlier diagnosis. Nonetheless, at a cutpoint of 5.7% (39 mmol/mol), the current cutpoint for prediabetes outside of pregnancy, the sensitivity was 21%, but the specificity was very high at 95%, which is very similar to estimates reported in a prior study of 13% and 94%, respectively 6 . There are two important things to note from our findings.…”

Section: Discussionsupporting

confidence: 85%

“…A few prior studies have examined if HbA 1c measured in the first trimester is useful for early predication of GDM 3 – 6 ; however, these studies have been among high-risk populations only 4 , 5 , evaluated an HbA 1c threshold only of 5.7% (39 mmol/mol), corresponding to prediabetes outside of pregnancy 6 , or used GDM diagnosed in the first trimester only as the outcome 3 . Other studies have focused primarily on HbA 1c measured in the second trimester or at the time of GDM diagnosis 7 – 9 .…”

Section: Introductionmentioning

confidence: 99%

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HbA1c Measured in the First Trimester of Pregnancy and the Association with Gestational Diabetes

Hinkle

Tsai

Rawal

et al. 2018

Sci Rep

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We aimed to examine the prospective association between first trimester HbA1c and gestational diabetes (GDM) and explore the utility of HbA1c for prediction of GDM. We used data from a case-control study within the prospective NICHD Fetal Growth Studies-Singleton Cohort (2009–2013), which enrolled 2,802 women at 12 U.S. clinical centers. HbA1c was measured in GDM cases (n = 107) and matched controls (n = 214) targeted at 8–13, 16–22, 24–29, and 34–37 gestational weeks. We excluded women with HbA1c ≥ 6.5% (48 mmol/mol) at enrollment (n = 3) or who had a hemoglobin variant (n = 6). At 8–13 gestational weeks, women who later developed GDM had significantly higher HbA1c (5.3[standard deviation 0.3]%; 34[4]mmol/mol) than women without GDM (5.1[0.3]%; 32[3] mmol/mol) (P ≤ 0.001); this difference remained significant throughout pregnancy. Each 0.1% (1 mmol/mol) HbA1c increase at 8–13 weeks was associated with an adjusted 22% increased GDM risk (95% confidence interval 1.09–1.36). First trimester HbA1c significantly improved GDM prediction over conventional risk factors (AUC 0.59 vs 0.65; P = 0.04). In conclusion, women who develop GDM may have impaired glucose homeostasis early in or prior to pregnancy, as indicated by their elevated first trimester HbA1c. First trimester HbA1c may aid in early identification of at risk women.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

HbA1c Measured in the First Trimester of Pregnancy and the Association with Gestational Diabetes

Hinkle

Tsai

Rawal

et al. 2018

Sci Rep

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“…In a retrospective analysis Osmundson et al showed that risk for GDM was increased by 50% (adjusted RR, 1.48; 95% CI 1.15 to 1.89) in women with first trimester HbA1c of 5.7%–6.4% compared with women with an HbA1c in normal range. 17 Other studies concluded similarly that HbA1c levels referred for pre-diabetes outside of pregnancy are associated with GDM manifestation and hereby supported the prognostic applicability of HbA1c in GDM risk prediction. 6 7 18 Of interest, in a very recent retrospective cohort study pregravid HbA1c measured at median 1.4 years before pregnancy was shown to be a robust predictor of GDM.…”

Section: Discussionsupporting

confidence: 67%

“…Our observations of a relatively high specificity but low sensitivity at an HbA1c cut-off of 5.7% for GDM development are very similar to the findings of the retrospective study by Osmundson et al , who equally used the IADPSG criteria for GDM diagnosis and applied the same threshold for their analysis. 17 As far as applicable, we could further extract similar test characteristics (ie, specificity and sensitivity) for a cut-point of 5.7% from studies, which differ regarding to diagnosis criteria (ie, the two-step screening by Carpenter and Coustan criteria with preceding challenge test) and the primary choice of a lower threshold. 7 20 21 Further, it has to be considered that HbA1c changes throughout pregnancy 7 which may explain why only moderate correlations are detectable between early HbA1c and glucose examinations in third trimester.…”

Section: Discussionmentioning

confidence: 99%

HbA1c during early pregnancy reflects beta-cell dysfunction in women developing GDM

Bozkurt

Göbl

Leitner

et al. 2020

BMJ Open Diab Res Care

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IntroductionIt is of current interest to assess eligibility of hemoglobin A1c (HbA1c) as a screening tool for earlier identification of women with risk for more severe hyperglycemia in pregnancy but data regarding accuracy are controversial. We aimed to evaluate if HbA1c mirrors pathophysiological precursors of glucose intolerance in early pregnancy that characterize women who develop gestational diabetes mellitus (GDM).Research design and methods220 pregnant women underwent an HbA1c measurement as well as an oral glucose tolerance test (OGTT) with multiple measurements of glucose, insulin and C-peptide for evaluation of insulin sensitivity and beta-cell function at 16th gestational week (IQR: 14–18). Clinical follow-ups were performed until end of pregnancy.ResultsIncreased maternal HbA1c ≥5.7% (39 mmol/mol) corresponding to pre-diabetes outside of pregnancy was associated with altered glucose dynamics during the OGTT. Pregnancies with early HbA1c ≥5.7% showed higher fasting (90.4±13.2 vs 79.7±7.2 mg/dL, p<0.001), mean (145.6±31.4 vs 116.2±21.4 mg/dL, p<0.001) as well as maximum glucose concentrations and tended to a delay in reaching the maximum glucose level compared with those with normal-range HbA1c (186.5±42.6 vs 147.8±30.1 mg/dL, p<0.001). Women with increased HbA1c showed impaired beta-cell function and differences in disposition index independent of body mass index status. We observed a high specificity for the HbA1c cut-off of 5.7% for GDM manifestation (0.96, 95% CI 0.91 to 0.98) or need of glucose-lowering medication (0.95, 95% CI 0.90 to 0.98) although overall predictive accuracy was moderate to fair. Further, elevated HbA1c was associated with higher risk for delivering large-for-gestational-age infants, also after adjustment for GDM status (OR 4.4, 95% CI 1.2 to 15.0, p=0.018).ConclusionsHbA1c measured before recommended routine screening period reflects early pathophysiological derangements in beta-cell function and glucose disposal that are characteristic of GDM development and may be useful in early risk stratification.

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“…GDM was diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria using a one-step 75-g, 2-h OGTT. The results indicated a first-trimester HbA1c level of 5.7–6.4% was associated with a low sensitivity (13%) and a 94% specificity in the prediction of GDM [21]. In a study by Renz and colleagues, GDM was diagnosed by the World Health Organization (WHO) 1999 and American Diabetes Association (ADA)/WHO 2013 criteria.…”

Section: Discussionmentioning

confidence: 99%

Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women

Wang

et al. 2017

PLoS ONE

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BackgroundThe objective of this study was to investigate the associations among the mid-pregnancy glycated hemoglobin A1c (HbA1c) level, gestational diabetes (GDM), and risk of adverse pregnancy outcomes in women without overt diabetes and with positive 50-g, 1-h glucose challenge test (GCT) results (140 mg/dL or greater).MethodsThis prospective study enrolled 1,989 pregnant Taiwanese women. A two-step approach, including a 50-g, 1-h GCT and 100-g, 3-h oral glucose tolerance test (OGTT), was employed for the diagnosis of GDM at weeks 23–32. The mid-pregnancy HbA1c level was measured at the time the OGTT was performed. A receiver operating characteristic (ROC) curve was used to determine the relationship between the mid-pregnancy HbA1c level and GDM. Multiple logistic regression models were implemented to assess the relationships between the mid-pregnancy HbA1c level and adverse pregnancy outcomes.ResultsAn ROC curve demonstrated that the optimal mid-pregnancy HbA1c cut-off point to predict GDM, as diagnosed by the Carpenter-Coustan criteria using a two-step approach, was 5.7%. The area under the ROC curve of the mid-pregnancy HbA1c level for GDM was 0.70. Compared with the levels of 4.5–4.9%, higher mid-pregnancy HbA1c levels (5.0–5.4, 5.5–5.9, 6.0–6.4, 6.5–6.9, and >7.0%) were significantly associated with increased risks of gestational hypertension or preeclampsia, preterm delivery, admission to the neonatal intensive care unit, low birth weight, and macrosomia (the odds ratio [OR] ranges were 1.20–9.98, 1.31–5.16, 0.88–3.15, 0.89–4.10, and 2.22–27.86, respectively).ConclusionsThe mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in high-risk Taiwanese women. However, it lacked adequate sensitivity and specificity to replace the two-step approach in the diagnosis of GDM. The current study comprised a single-center prospective study; thus, additional, randomized control design studies are required.

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First Trimester Hemoglobin A1c Prediction of Gestational Diabetes

Cited by 43 publications

References 15 publications

HbA1c Measured in the First Trimester of Pregnancy and the Association with Gestational Diabetes

HbA1c Measured in the First Trimester of Pregnancy and the Association with Gestational Diabetes

HbA1c during early pregnancy reflects beta-cell dysfunction in women developing GDM

Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women

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