First‐trimester glycosylated hemoglobin (HbA1c) and maternal characteristics in the prediction of gestational diabetes: An observational cohort study. (16th December 2022)

• Record Type: Journal Article
• Authors: Amylidi‐Mohr, Sofia; Lang, Cheryl; Mosimann, Beatrice; Fiedler, Georg M.; Stettler, Christoph; Surbek, Daniel; Raio, Luigi
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 102:Number 3(2023)
• Page Start: 294
• Page End: 300
• Publication Date: 2022-12-16
• Subjects: gestational diabetes -- glycosylated hemoglobin A1c -- pregnancy complications -- screening method; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.14495
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: Introduction: This study aimed to investigate the extent to which gestational diabetes mellitus (GDM) can be predicted in the first trimester by combining a marker of growing interest, glycosylated hemoglobin A1c (HbA1c), and maternal characteristics. Material and methods: This observational study was conducted in the outpatient obstetric department of our institution. The values of HbA1c and venous random plasma glucose were prospectively assessed in the first trimester of pregnancy. We determined maternal characteristics that were independent predictors from the regression analysis and calculated areas under the receiver‐operating curves by combining the maternal age, body mass index, previous history of GDM, and first‐degree family history for diabetes mellitus. Moreover we investigated the predictive capability of HbA1c to exclude GDM. Patients with a first‐trimester HbA1c level of 6.5% (48 mmol/mol) or more were excluded. The study was registered at ClinicalTrials.gov ID: NCT02139254. Results: We included 785 cases with complete dataset. The prevalence of GDM was 14.7% (115/785). Those who developed GDM had significantly higher HbA1c and random plasma glucose values ( p < 0.0001 and p = 0.0002, respectively). In addition, they had a higher body mass index, were more likely to have a history of GDM and/or a first‐degree family history of diabetes. When these maternal characteristics were combined with the first‐trimester HbA1c and random plasma glucose the combined area under the receiver operating characteristics curve was 0.76 (95% CI 0.70–0.81). Conclusions: Our results indicate that HbA1c and random plasma glucose values combined with age, body mass index, and personal and family history, allow the identification of women in the first trimester who are at increased risk of developing GDM. Abstract : A combination of maternal history and characteristics with easy accessible biochemical markers may reveal a possible screening method. Similar to the preeclampsia screening, a prediction model for gestational diabetes would allow an early intervention to reduce adverse pregnancy outcome.