Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus
SETTINGS: Primary health care. Single tertiary referral centre, Tasmania, Australia.
PARTICIPANTS: A direct comparison between HbA1c levels and the OGTT results in pregnant women, tested concurrently at the 24-28 gestational week, was undertaken. A full profile of 480 pregnant women during the period from September 2012 to July 2014 was completed. Median and mean age of participants was 29 years (range 18-47 years).
INTERVENTIONS: A simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed.
RESULTS: The number of women who had GDM according to OGTT criteria was 57, representing 11.9% of the evaluated 480 pregnant women. Using a cut-off value for HbA1c at 5.1% (32 mmol/mol) for detecting GDM showed sensitivity of 61% and specificity of 68% with negative predictive value (NPV) of 93%, versus sensitivity of 27% and specificity of 95% with NPV of 91% when using HbA1c cut-off value of 5.4% (36 mmol/mol).
CONCLUSIONS: Our results suggest that pregnant women with an HbA1c of≥5.4% (36 mmol/mol) should proceed with an OGTT. This may result in a significant reduction in the burden of testing on both patients and testing facility staff and resources. Further investigations are required to integrate and optimise the HbA1c as a single, non-fasting, screening tool for GDM.
Publication titleBMJ Open
Department/SchoolMenzies Institute for Medical Research
PublisherB M J Group
Place of publicationUnited Kingdom
Rights statementLicensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/