Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
J Matern Fetal Neonatal Med. 2021 Jun;34(12):1970-1977. doi: 10.1080/14767058.2019.1651837. Epub 2019 Aug 12.
To examine the accuracy of maternal serum glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in predicting gestational diabetes at the first trimester in Turkish women with a low-risk pregnancy and its relationship with fetal birth weight.
This cohort study was conducted retrospectively in a tertiary referral hospital from January 2010 to January 2017. HbA1c and FPG serum concentrations were measured in 670 pregnant women at the first-trimester screening. HbA1c and FPG concentrations of women who subsequently developed gestational diabetes mellitus (GDM) were compared to those who did not, and its relationship with fetal weight was investigated.
First-trimester screening was performed on 608 pregnant women, of whom 69 (11.3%) women had developed GDM. Median HbA1c and FPG concentrations were significantly higher in women developing GDM ( = 69) in comparison to those with uncomplicated pregnancies ( = 539) (5.31 ± 0.58% versus 5.01 ± 0.45%, < .001 and 89.74 ± 8.71% versus 84.09 ± 9.16%, < .001, respectively). The cut-off value calculated with the highest Youden index was HbA1c levels above 5.6% with a sensitivity of 34.78%, specificity of 89.8%, with a diagnostic accuracy of 83.55%, and FPG levels above 86.85 mg/dl with a sensitivity of 69.57%, specificity of 61.78%, with a diagnostic accuracy of 62.66%. The calculated odds ratio (OR) for HbA1c > 5.6% and FPG > 86 mg/dl were 4.69 (95% CI: 2.66-8.29), and 3.7 (95% CI: 2.15-6.35), respectively. HbA1c and FPG combined had improved the predictive capability for GDM (OR: 7.26, 95% CI: 3.71-14.19). According to correlation analyses, a noteworthy positive correlation was found between HbA1c and, FPG, 50 g GCT, age, BMI, parity, and birth weight. However, there was no correlation between FPG and birth weight.
Diagnostic accuracy of HbA1c for GDM prediction in Turkish women with a low-risk pregnancy is 83.55% with a very good negative predictive value of 91.49%. HbA1c and FPG combined enhanced the predictive capability for GDM. In addition, there is a positive relationship between HbA1c and 50 g GCT, and birth weight. However, to suggest HbA1c as a potential screening test for gestational diabetes mellitus, further research is warranted.
探讨在土耳其低危妊娠妇女中，母体血清糖化血红蛋白（HbA1c）和空腹血糖（FPG）水平在预测妊娠早期糖尿病中的准确性及其与胎儿出生体重的关系。
本队列研究回顾性分析了 2010 年 1 月至 2017 年 1 月在一家三级转诊医院进行的研究。在妊娠早期筛查时测量了 670 名孕妇的 HbA1c 和 FPG 血清浓度。比较了随后发生妊娠期糖尿病（GDM）的妇女与未发生 GDM 的妇女的 HbA1c 和 FPG 浓度，并研究了其与胎儿体重的关系。
对 608 名孕妇进行了妊娠早期筛查，其中 69 名（11.3%）孕妇发生了 GDM。与无并发症妊娠（n=539）相比，发生 GDM（n=69）的妇女的中位 HbA1c 和 FPG 浓度明显更高（分别为 5.31±0.58%和 5.01±0.45%，均<0.001；89.74±8.71%和 84.09±9.16%，均<0.001）。使用最高 Youden 指数计算的截断值为 HbA1c 水平>5.6%，其灵敏度为 34.78%，特异性为 89.8%，诊断准确性为 83.55%，FPG 水平>86.85mg/dl，其灵敏度为 69.57%，特异性为 61.78%，诊断准确性为 62.66%。HbA1c>5.6%和 FPG>86mg/dl 的计算比值比（OR）分别为 4.69（95%CI：2.66-8.29）和 3.7（95%CI：2.15-6.35）。HbA1c 和 FPG 联合使用可提高 GDM 的预测能力（OR：7.26，95%CI：3.71-14.19）。相关性分析显示，HbA1c 与 FPG、50gGCT、年龄、BMI、产次和出生体重之间存在显著正相关。然而，FPG 与出生体重之间没有相关性。
在土耳其低危妊娠妇女中，HbA1c 对 GDM 预测的诊断准确性为 83.55%，阴性预测值非常好（91.49%）。HbA1c 和 FPG 联合使用可提高 GDM 的预测能力。此外，HbA1c 与 50gGCT 和出生体重之间存在正相关关系。然而，HbA1c 作为妊娠期糖尿病的潜在筛查试验仍需要进一步研究。
