Glycated hemoglobin (HbA1c) in diagnosis of gestational diabetes mellitus
DOI:
https://doi.org/10.55629/pakjpathol.v35i1.805Abstract
Objective: To evaluate the diagnostic accuracy of glycated hemoglobin for diagnosing gestational diabetes mellitus.
Material and Methodology: This cross-sectional comparative study was conducted at the Department of Chemical Pathology and Endocrinology, Reference Laboratory, Rawalpindi from June 2023 to October 2023. The study included women having gestational amenorrhea between 24th to 28th weeks, who gave informed written consent for a 75-gram oral glucose tolerance test (OGTT) at Reference Laboratory Rawalpindi. Women with diabetes, hypertension, hemoglobin< 10g/dl, on steroid treatment, with gastrointestinal or thyroid diseases were excluded. The medical history and anthropometric measurement (height, weight, body mass index (BMI) and blood pressure were recorded on a predesigned proforma. Blood sample for glucose was taken in sodium fluoride tubes and HbA1c in potassium EDTA tubes. American Diabetes Association criteria 2023 was used to diagnose gestational diabetes mellitus (GDM). Study participants were divided into two groups on basis of 75g- OGTT results; Group 1 included GDM and Group 2 Normal Glucose Tolerance (NGT).
Results: A total of 100 pregnant ladies were enrolled whose ages ranged from 15-45 (mean & SD 29±5 & 31±6 years in groups 1& 2 respectively). Mean fasting plasma glucose (FPG) was 5.11±0.6 mmol/l & 4.57±0.4mmol/l, and HbA1c was 6.12%±1 & 5.26% ±0.48 in groups 1& 2 respectively. GDM was found in 19 (group 1) of 100 patients, while 81 responded normally. HbA1c at 5.6% has 84.2% sensitivity, 87.6% specificity, 61.5% PPV, 95.9% NPV and 87% diagnostic accuracy. FPG, 1hr glucose and HbA1c exhibited an Area Under Curve (AUC) by Receiver Operating Characteristic (ROC) Curve of 0.762, 0.801 & 0.894 respectively.
Conclusion: HbA1c has shown higher diagnostic yield for gestational diabetes mellitus and can be used as a screening test.
Keywords: Glycated hemoglobin, Oral glucose tolerance test, Gestational diabetes mellitus
References
Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, Hoegfeldt CA et al. IDF Diabetes Atlas Committee Hyperglycaemia in Pregnancy Special Interest Group. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria. Diabetes Res Clin Pract. 2022; 183: 109050. doi: 10.1016/j.diabres.2021.109050
Inam I, Madnia E, Ammar A, Sajjad S. Prevalence of Gestational Diabetes Mellitus in Pakistan: A Cross Sectional Study. Pak J Med Health Sci 2022; 16; 241-3.
Bellamy L, Casas JP, Hingorani AD, & Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet 2009; 373(9677): 1773-9.
Mou SS, Gillies C, Hu J, Danielli M, Al Wattar BH, Khunti K, Tan BK. Association between HbA1c Levels and Fetal Macrosomia and Large for Gestational Age Babies in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 17,711 Women. Journal of Clinical Medicine 2023; 12(11):3852. https://doi.org/10.3390/jcm12113852
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020. Diabetes Care 2020;43(Suppl1):S14–s31.
DOI:10.2337/dc20-S002
Hes RC, Rowan J, Florkowski CM. Is there a role for HbA1c in pregnancy? Curr Diab Rep 2016;16(1):5.
Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33:676-82.
American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2022; 45(Supplement_1), S1-S198.
Balani J, Hyer S, Johnso A, Shehata H. Predicting gestational diabetes mellitus by first trimester HbA1c: a retrospective study in women with moderate to severe obesity. Pract Diab 2023, 40: 22-27. https://doi.org/10.1002/pdi.2466
Deng, Y., Cheng, D., Liao, G. Tan X, Yang J. Trimester-specific reference intervals for hemoglobin A1c in non-diabetic pregnancy in a Chinese population. BMC Pregnancy Childbirth 2023; 23; 671.
DOI: https://doi.org/10.1186/s12884-023-05980-0
The role of frst-trimester HbA1c in the early detection of gestational diabetes. Valadan M, Bahramnezhad Z, Golshahi F, Feizabad E. BMC Pregnancy and Childbirth 2022; 22:71.
DOI: https://doi.org/10.1186/s12884-021-04330-2
Retnakaran R, Shah BR. Pregravid HbA1c and Glucose Measurement to Rule Out Future Gestational Diabetes Mellitus and Reduce the Need for Oral Glucose Tolerance Testing in Pregnancy. Diabetes Care 2020;43:e93–5.
Kattini R, Hummelen R, Kelly L. Early gestational diabetes mellitus screening with glycated hemoglobin: A systematic review. J Obstet Gynaecol Can 2020; 42(11): 1379–84.
DOI: 10.1016/j.jogc.2019.12.015
Fong A, Serra AE, Gabby L, Wing DA, Berkowitz KM. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. Am J Obstet Gynecol. 2014; 211(6): 641.e1–641.e7.
DOI: 10.1016/j.ajog.2014.06.016
Liu X, Wu N, Al-Mureish A. A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes. Int J Gen Med 2021; 14:1155-65.
DOI: 10.2147/IJGM.S296316
Hinkle SN, Tsai MY, Rawal S. HbA1c measured in the first trimester of pregnancy and the association with gestational diabetes. Sci Rep. 2018; 8: 12249.
Amylidi S, Mosimann B, Stettler C, et al. First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes. Acta Obstet Gynecol Scand. 2016;95:93–7.
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D et al. On behalf of the American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S254–S266.
DOI: https://doi.org/10.2337/dc23-S015
Khan SH, Manzoor R, Baig AH, Tariq B, Ayub N, Sarwar S, et al. Role of HbA1c in diagnosis of gestational diabetes mellitus. J Pak Med Assoc 2020; 70(10): 1731-36.
DOI: 10.5455/JPMA.24080. PMID: 33159743.
Bozkurt L, Göbl CS, Leitner K. HbA1c during early pregnancy reflects beta-cell dysfunction in women developing GDM. BMJ Open Diab Res Care 2020; 8: e001751. DOI:10.1136/ bmjdrc-2020-001751
Osmundson SS, Zhao BS, Kunz L. First trimester hemoglobin A1c prediction of gestational diabetes. Am J Perinatol 2016;33:977–82.
Negrea MC, Oriot P, Courcelles A, Gruson D, Alexopoulou O. Performance of glycated hemoglobin A1c for the diagnosis of gestational diabetes mellitus during the SARS-CoV-2 pandemic in Belgium (2020-2021). Eur J Obstet Gynecol Reprod Biol. 2023; 289: 36-41.
DOI: 10.1016/j.ejogrb.2023.08.368.
Singh V, Warman S. Association of early pregnancy values of glycosylated hemoglobin and the development of gestational diabetes mellitus. Cureus. 2023; 15(10): e46685.
DOI:10.7759/cureus.46685
Siricharoenthai P, Phupong V. Diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus. J Matern Fetal Neonatal Med 2020; 33(20): 3497-3500.
DOI: 10.1080/14767058.2019.1576169.
Lai Y, Chen H, Du Z, Zhou S, Xu W, Li T. The diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus among Chinese pregnant individuals. Ann Transl Med 2020; 8(16): 1014. DOI: 10.21037/atm-20-5464
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Dr Muhammad Younas, Dr Asif Ali, Dr Muhammad Qaisar Alam Khan, Dr SajIda Shaheen; Arooj Ishtiaq; Dr Maimoona Roghani
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
