Trimester-specific reference intervals for haemoglobin A1c (HbA1c) in pregnancy

O’Connor, Catherine A.; O’Shea, Paula; Owens, Lisa; Carmody, Louise; Avalos, G; Nestor, L; Lydon, K; Dunne, Fidelma

doi:10.1515/cclm.2011.397

Cited by 50 publications

(45 citation statements)

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“…This can occur, for example, in patients with rapid changes in glycemic control, patients with variant hemoglobins [320,322], iron-deficiency anemia [323][324][325][326], pregnancy [327][328][329], or HIV infection [330,331]. Abnormally low-HbA1c reading can be expected under conditions such as rapid loss of glycemic control [332,333], conditions that decrease erythrocyte lifespan such as hemolytic anemia [325], liver cirrhosis [334,335], hemorrhage, chronic kidney disease 249 Glycated Serum Albumin and AGE Receptors [336][337][338][339], variant hemoglobin [320,322,340], and hemoglobin in neonates [341,342].…”

Section: Glycated Hemoglobin Hba1cmentioning

confidence: 99%

Glycated Serum Albumin and AGE Receptors

Vetter

2015

Advances in Clinical Chemistry

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Section: Glycated Hemoglobin Hba1cmentioning

confidence: 99%

Glycated Serum Albumin and AGE Receptors

Vetter

2015

Advances in Clinical Chemistry

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“…Whilst potentially helpful in a few cases, this is likely to miss many patients with pre-existing diabetes as HbA1c falls during a normal pregnancy. 11 In those with known pre-existing diabetes the recommendations are to consider measuring HbA1c levels in the second and third trimesters, to assess the level of risk for the pregnancy, while not using HbA1c levels routinely during this period. These statements appear somewhat contradictory.…”

Section: Antenatal Carementioning

confidence: 99%

Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (NG3)

2015

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More flexibility is offered around recommended delivery timing: 37+0 weeks to 38+6 weeks for women with types 1 and 2 diabetes; prior to 40+6 in GDM (and earlier if complications arise). Postnatal testing following GSM should be by fasting glucose (not OGTT) at 6-13 weeks post partum. Testing later than this can use HbA1c.Introducing these changes will have resource implications, including a likely increase in the number of women diagnosed with GDM. Br J Diabetes Vasc Dis 2015;15:107-111

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“…O'Connor and colleagues found trimester specific reference interval of Glyco HbA1c in 246 non diabetic pregnant women with normal haemoglobin: the first trimester range was 4.8-5.5% (29-37 mmol/mol), second trimester 4.4-5.4% (25-36 mmol/mol) and third trimester 4.4-5.4% (25-36 mmol/mol). 10 A meta-analysis of 43 studies from 2001 to 2012 with varying diagnostic criteria for GDM and cut off values for Glyco HbA1c was done. It involved 2812 GDM patients in China who were compared with 5918 controls.…”

Section: Discussionmentioning

confidence: 99%

Use of glycosylated HbA1c and random blood sugar as a screening tool for gestational diabetes mellitus in first trimester

Amreen¹,

Mundkur²,

Shetty³

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONGestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. It is well known that GDM is associated with maternal and fetal morbidity such as polyhydramnios, preeclampsia, operative delivery, macrosomia, shoulder dystocia, intrauterine growth retardation, neonatal hypoglycaemia and perinatal mortality.The prevalence of GDM varies from 3.8% to 21% in various parts of India based on geographic location and diagnostic methods used.1 Indians are at eleven fold increased risk of developing glucose intolerance during pregnancy than European women.2 Recently WHO adopted the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, which has resulted in an increase in the detected incidence of GDM.3 The guidelines recommends that at 24-28 weeks a 75 g oral glucose tolerance test (OGTT) should be done for all pregnant women.GTT is an inconvenient test as it consumes time, the pregnant women must fast and wait for 2 hours and should have at least 3 venipunctures. They also have nausea and vomiting due the 75 g glucose and delayed gastric emptying. Moreover, the universal screening recommendation has increased the testing burden. With these methods there was a possibility of missing patients with abnormal sugars in first trimester. ABSTRACTBackground: GDM cases go unidentified with inadequate screening methods in first trimester which in turn increases the maternal and neonatal morbidity which is preventable. The purpose of the study was to find out a cut off level for HbA1c and RBS at first trimester for screening Gestational diabetes mellitus (GDM). Methods: Observational study on pregnant women in a tertiary care teaching institution. Early screening with HbA1c and RBS at booking visit and followed up to second trimester GTT at 24-28 weeks. Pregnant women were divided into 2 groups based on GTT results. Pregnant women with overt diabetes and multiple pregnancy were not included in the study. Results: Out of the 151 subjects, 76 cases were diagnosed with GDM while the other 75 were found to be non-GDM by following the 75g GTT approved by IADPSG. According to our study optimal cut-off for HbA1C was found to be 5.496±0.48 %, as it gives a sensitivity of 80% and specificity of 55.3%. Optimal cut-off for RBS was found to be 112±0.77 mg/dl, as it gives a sensitivity of 35.55 and specificity of 94.7%. Conclusions: Glyco Hb A1c and RBS can be used as screening tool for the diagnosis of GDM. The likelihood of having GDM at a cutoff of Glyco HbA1c 5.5% is 1.8 times and RBS level 112mg/dl is 7 times in pregnant women.

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Trimester-specific reference intervals for haemoglobin A1c (HbA1c) in pregnancy

Abstract: HbA(1c) trimester-specific reference intervals are required to better inform the management of pregnancies complicated by diabetes.

Cited by 50 publications

References 1 publication

Glycated Serum Albumin and AGE Receptors

Glycated Serum Albumin and AGE Receptors

Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (NG3)

Use of glycosylated HbA1c and random blood sugar as a screening tool for gestational diabetes mellitus in first trimester

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