Khalafallah Alhossain, Phuah Eileen, Al-Barazan Abdul Majeed, Nikakis Irena, Radford Andrea, Clarkson Wade, Trevett Clinton, Brain Terry, Gebski Val, Corbould Anne
Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia Menzies Institute for Medical Research, University of Tasmania, Launceston, Tasmania, Australia.
Department of Obstetrics and Gynaecology, Launceston General Hospital and Royal Hobart Hospital, Launceston, Tasmania, Australia.
BMJ Open. 2016 Apr 4;6(4):e011059. doi: 10.1136/bmjopen-2016-011059.
The oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the most accepted measure of chronic glycaemia outside of pregnancy. HbA1c is an uncomplicated test, less time consuming, does not require any specific patient preparation and is considered straightforward compared with the OGTT. Therefore, we prospectively tested the utility of the HbA1c when used as a screening tool in pregnancy for gestational diabetes mellitus (GDM).
Primary health care. Single tertiary referral centre, Tasmania, Australia.
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).
A simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed.
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).
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.
ACTRN12611000739910.
口服葡萄糖耐量试验（OGTT）是一项繁琐的检查，耗时、费力，且孕妇往往耐受性差。迄今为止，糖化血红蛋白（HbA1c）是孕期外慢性血糖水平最被认可的检测指标。HbA1c检查简单，耗时少，无需患者进行任何特殊准备，与OGTT相比被认为很直接。因此，我们前瞻性地测试了将HbA1c用作孕期妊娠期糖尿病（GDM）筛查工具的效用。
初级卫生保健机构。澳大利亚塔斯马尼亚州的单一三级转诊中心。
对孕24 - 28周时同时进行检测的孕妇的HbA1c水平和OGTT结果进行直接比较。完成了2012年9月至2014年7月期间480名孕妇的完整资料。参与者的年龄中位数和平均数为29岁（范围18 - 47岁）。
对我院连续就诊的一组孕妇同时进行HbA1c与标准OGTT的前瞻性评估。
根据OGTT标准，患有GDM的女性有57名，占所评估的480名孕妇的11.9%。以HbA1c 5.1%（32 mmol/mol）作为检测GDM的临界值，灵敏度为61%，特异度为68%，阴性预测值（NPV）为93%；而当HbA1c临界值为5.4%（36 mmol/mol）时，灵敏度为27%，特异度为95%，NPV为91%。
我们的结果表明，HbA1c≥5.4%（36 mmol/mol）的孕妇应进行OGTT检查。这可能会显著减轻患者以及检测机构工作人员和资源的检测负担。需要进一步研究以整合并优化将HbA1c作为GDM的单一、非空腹筛查工具。
ACTRN12611000739910。
