Screening for Gestational Diabetes Mellitus by Measuring Glycated Hemoglobin Can Reduce the Use of the Glucose Challenge Test

다국어 초록 (Multilingual Abstract)

Background: Physiological changes during pregnancy, such as dilutional anemia and a reduced half-life of red blood cells, have prevented the use of glycated Hb (HbA1c) as a biomarker for gestational diabetes mellitus (GDM). Nevertheless, increasing evidence supports the use of HbA1c in GDM diagnostic strategies.We studied HbA1c as a biomarker of GDM and its possible use as a screening test to avoid the use of the glucose challenge test (GCT).
Methods: This case-control study involved 607 pregnant women between the 24th and 28th week of gestation. HbA1c level was determined, and GDM was diagnosed according to the National Diabetes Data Group criteria. The area under the ROC curve (AUC) was determined; two low and two high cut-off points were established to rule out GDM and classify high-risk pregnant women, respectively. For each cut-off, sensitivity (S), specificity (SP), and total number and percentage of GCTs avoided were determined.
Results: The AUC for HbA1c diagnostic performance was 0.68 (95% confidence interval 0.57–0.79). Using 4.6% HbA1c (27 mmol/mol) as the lower cut-off (S=100%), 14% of participants could avoid the GCT. Using 5.5% HbA1c (36 mmol/mol) as the upper cut-off (SP =94.5%), 6% of participants would be considered at high risk.
Conclusions: HbA1c can be used as a screening test prior to the GCT, thereby reducing the need for the GCT among pregnant women at a low risk of GDM.

참고문헌 (Reference)

1 WHO, "Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation" 1-25, 2011

2 Ye M, "The utility of HbA1c for screening gestational diabetes mellitus and its relationship with adverse pregnancy outcomes" 114 : 43-49, 2016

3 Donovan L, "Screening tests for gestational diabetes : a systematic review for the US Preventive Services Task Force" 159 : 115-122, 2013

4 Benhalima K, "Screening for gestational diabetes in Europe : where do we stand and how to move forward : A scientific paper commissioned by the European Board & College of Obstetrics and Gynaecology(EBCOG)" 201 : 192-196, 2016

5 Bonongwe P, "Reproducibility of a 75G oral glucose tolerance test in pregnant women" 43 : 333-338, 2015

6 Aceituno Velasco L, "Procesoasistencialintegradoembarazo, parto y puerperio" 3 : 1-73, 2014

7 Committee on Practice Bulletins - Obstetrics, "Practice Bulletin No. 137: Gestational diabetes mellitus" 122 : 406-416, 2013

8 "Plan integral de diabetes en Andalucía. Análisissituación 2013"

9 American Diabetes Association, "Management of diabetes in pregnancy: standards of medical care in diabetes - 2019" 42 (42): S165-S172, 2019

10 International Expert Committee, "International expert committee report on the role of the A1C assay in the diagnosis of diabetes" 32 : 1327-1334, 2009

11 International Association of Diabetes, "International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy" 33 : 676-682, 2010

12 Lowe LP, "Hyperglycemia and adverse pregnancy outcome(HAPO)Study : associations of maternal A1C and glucose with pregnancy outcomes" 35 : 574-580, 2012

13 HAPO Study Cooperative Research Group, "Hyperglycemia and adverse pegnancyoutcomes" 358 : 1991-2002, 2008

14 Renz PB, "HbA1c test as a tool in the diagnosis of gestational diabetes mellitus" 10 : e0135989-, 2015

15 Kwon SS, "HbA1c for diagnosis and prognosis of gestational diabetes mellitus" 110 : 38-43, 2015

16 Khalafallah A, "Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus" 6 : e011059-, 2016

17 Agarwal MM, "Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins" 51 : 67-73, 2001

18 Maesa JM, "Evaluation of Bio-Rad D-100 HbA1c analyzer against Tosoh G8 and Menarini HA-8180V" 5 : 57-64, 2016

19 Wolfenbuttel BH, "Ethnic differences in glycemic markers in patients with type 2 diabetes" 36 : 2931-2936, 2013

20 Farrar D, "Different strategies for diagnosing gestational diabetes to improve maternal and infant health" 1 : CD007122-, 2015

21 National Institute for Health and Care Excellence, "Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period"

22 Carpenter MW, "Criteria for screening tests for gestational diabetes" 144 : 768-773, 1982

23 National Diabetes Data Group, "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance" 28 : 1039-1057, 1979

24 GrupoEspañol Diabetes y Embarazo, "Asistencia a la gestante con diabetes. Guía de prácticaclínicaactualizadaen 2014" 31 : 45-59, 2015

25 Maesa JM, "Application of six sigma model to evaluate the analytical quality of four HbA1c analyzers" 63 : 79-83, 2017