Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 15 , ISSUE 2 ( March-April, 2023 ) > List of Articles


Glycated Hemoglobin: A Useful Screening Tool for Gestational Diabetes Mellitus

Gurbani Kaur Arora, Kavita Mandrelle, Jubbin Jagan Jacob

Keywords : Gestational diabetes mellitus, Glycated hemoglobin, Maternal and neonatal outcome

Citation Information : Arora GK, Mandrelle K, Jacob JJ. Glycated Hemoglobin: A Useful Screening Tool for Gestational Diabetes Mellitus. J South Asian Feder Obs Gynae 2023; 15 (2):198-202.

DOI: 10.5005/jp-journals-10006-2201

License: CC BY-NC 4.0

Published Online: 11-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Gestational diabetes mellitus (GDM) and adverse pregnancy outcomes are correlated. The oral glucose tolerance test (OGTT) is the gold standard method for screening GDM. Glycated hemoglobin (HbA1c) levels are a useful screening test for detecting GDM. The use of HbA1c in screening for GDM has been demonstrated by several studies. Objectives: To find the usefulness of HbA1c levels in diagnosing gestational diabetes mellitus and its association with adverse maternal and neonatal effects. Materials and methods: This prospective cohort study was conducted at Christian Medical Hospital, Ludhiana. About 500 antenatal women attending the outpatient department were subjected to 75 gm OGTT, and HbA1c and GDM being diagnosed using DIPSI criteria. The perinatal outcomes were compared in women with and without GDM. Results: Among the 500 antenatal patients evaluated, 23 were lost to follow-up and excluded from the study. The incidence of GDM was 16.8% (n = 80). Women with GDM and without GDM had a mean HbA1c level of 5.55 ± 0.74% and 4.95% ± 0.74%, respectively. The optimal HbA1c cut-off for diagnosing GDM was 5.15% with sensitivity of 74% and specificity of 69.8%. Conclusions: HbA1c with a cutoff of 5.15% can be used as a screening test and avoid the need of OGTT in approximately 50% of antenatal women.

  1. Soumya S, Rohilla M, Chopra S, et al. HbA1c: A useful screening test for gestational diabetes mellitus. Diabetes Technol Ther 2015;17(12):899–904. DOI: 10.1089/dia.2015.0041
  2. Adams KM, Li H, Nelson RL, et al. Sequelae of unrecognized gestational diabetes. Am J Obstet Gynecol 1998;178(6):1321–1332. DOI: 10.1016/s0002-9378(98)70339-4.
  3. González-Quintero VH, Istwan NB, Rhea DJ, et al. The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes. Diabetes Care 2007;30(3):467–470. DOI: 10.2337/dc06-1875.
  4. Dahiya K, Sahu J. Single step test for diagnosing gestational diabetes mellitus. J South Asian Feder Obs Gynae 2014;6(2):88–92. DOI: 10.5005/jp-journals-10006-1278.
  5. Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33(3):676–682. DOI: 10.2337/dc09-1848.
  6. Aldasouqi SA, Solomon DJ, Bokhari SA, et al. Glycohemoglobin A1c: A promising screening tool in gestational diabetes mellitus. Int J Diabetes Dev Ctries 2008;28(4):121–124. DOI: 10.4103/0973-3930.45271.
  7. Odsaeter IH, Asberg A, Vanky E, et al. HbA1c as screening for gestational diabetes mellitus in women with polycystic ovary syndrome. BMC Endocr Disord 2015;15:38. DOI: 10.1186/s12902-015-0039-9.
  8. Garner LA, Miller E, Katon J. First-trimester A1C as a tool to predict the development of gestational diabetes in high-risk women. Obstet Gynecol 2014;123:52S. DOI: 10.1097/01.AOG.0000447343.89639.52.
  9. Ho Y-R, Wang P, Lu M, et al. Associations of mid pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women. PLoS One 2017;12(5): e0177563. DOI: 10.1371/journal.pone.0177563.
  10. Berggren EK, Stewart T, Boggess K. 555: The association of glycosylated hemoglobin (HbA1c) with infant birthweight among women with gestational diabetes: A classification and regression tree (CART) analysis. Am J Obstet Gynecol 2012;206(Suppl):S252. DOI: 10.1016/j.ajog.2011.10.573.
  11. Mikkelsen MR, Nielsen SB, Stage E, et al. High maternal HbA1c is associated with overweight in neonates. Dan Med Bull 2011;58(9):A4309. PMID: 21893012.
  12. Gandhi RA, Brown J, Simm A, et al. HbA1c during pregnancy: Its relationship to meal related glycaemia and neonatal birth weight in patients with diabetes. Eur J Obstet Gynecol Reprod Biol 2008;138(1):45–48. DOI 10.1016/j.ejogrb.2007.08.011.
  13. Agarwal MM, Punnose J. Gestational diabetes: Implications of variation in diagnostic criteria. Int J Gynecol Obstet 2002;78(1):45–46. DOI: 10.1016/s0020-7292(02)00102-9.
  14. Agarwal MM, Punnose J, Dhatt GS. Gestational diabetes: Implications of variation in post-partum follow-up criteria. Eur J Obstet Gynecol Reprod Biol 2004;113(2):149–153. DOI: 10.1016/j.ejogrb.2003.09.021.
  15. Nankervis A, McIntyre HD, Moses RG, et al. Testing for gestational diabetes mellitus in Australia. Diabetes Care 2013;36(5):e64. DOI: 10.2337/dc12-2345.
  16. Garg R, Roy P, Agarwal P, et al. Gestational diabetes mellitus: Challenges in diagnosis and management. J South Asian Feder Obs Gynae 2018;10(1):54–60. DOI: 10.5005/jp-journals-10006-1558.
  17. Rajput R, Yogesh Y, Rajput M, et al. Utility of HbA1c for diagnosis of gestational diabetes mellitus. Diabetes Res Clin Pract 2012;98(1):104–107. DOI: 10.1016/j.diabres.2012.02.018.
  18. Mousavi SN, Kamali K, Mirbazel M, et al. The best cut-off value for HbA1c as a screening tool in Iranian women with gestational diabetes mellitus. J Family Reprod Health 2017;11(1):37–42. PMCID: PMC5664988.
  19. Jain R, Sharma M, Singh HV, et al. HbA1c (glycosylated hemoglobin)–A screening method on first antenatal visit in pregnant women for gestational diabetes mellitus. Indian Obstet Gynaecol 2020;10:19–25.
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