Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Womens Health (Larchmt). 2020 Dec;29(12):1559-1563. doi: 10.1089/jwh.2019.8203. Epub 2020 Jul 15.
Screening for diabetes in early pregnancy is recommended for high-risk women, however, the optimal test for the diagnosis of early gestational diabetes mellitus (GDM) is unknown. Thus, the objective of this study was to evaluate hemoglobin A (HbA) as a diagnostic test for early GDM compared with two-step testing. Retrospective cohort of women with prior GDM or obesity who had HbA and two-step testing <21 weeks' gestation. Early GDM was diagnosed by 1 hour, 50 g oral glucose challenge test (GCT) ≥135 mg/dL and ≥2 abnormal values on 3 hour, 100 g oral glucose tolerance test or GCT >200 mg/dL. The area under the receiver operating characteristic curve (AUC) evaluated HbA for diagnosis of early GDM. Of 243 women, 14 (5.8%) had early GDM by two-step testing. Median HbA levels were higher among women with GDM versus those without GDM (5.8% vs. 5.3%, < 0.001). The AUC for HbA compared with two-step testing was 0.80 (95% CI 0.69-0.91). The optimal HbA threshold was 5.6% (64% sensitivity, 84% specificity). HbA is moderately predictive of early GDM compared with two-step testing, and a threshold lower than that used for diabetes diagnosis among nonpregnant adults is justified.
早孕期对高危孕妇推荐进行糖尿病筛查，但早期妊娠糖尿病（GDM）的最佳诊断检测方法尚不清楚。因此，本研究旨在评估血红蛋白 A（HbA）作为早期 GDM 的诊断检测方法，与两步检测法相比。
这是一项回顾性队列研究，纳入了既往患有 GDM 或肥胖症、且在<21 孕周时进行了 HbA 和两步检测的女性。早期 GDM 通过 1 小时 50g 口服葡萄糖耐量试验（OGTT）≥135mg/dL 和/或 3 小时 100g OGTT 时≥2 个异常值或 GCT>200mg/dL 来诊断。接受者操作特征曲线（AUC）下面积评估 HbA 对早期 GDM 的诊断价值。
在 243 名女性中，有 14 名（5.8%）通过两步检测法确诊为早期 GDM。与无 GDM 的女性相比，GDM 女性的 HbA 中位数水平更高（5.8%比 5.3%，<0.001）。HbA 与两步检测法的 AUC 为 0.80（95%CI 0.69-0.91）。HbA 的最佳阈值为 5.6%（64%的敏感性，84%的特异性）。
与两步检测法相比，HbA 对早期 GDM 的预测能力中等，低于非妊娠成年人中用于诊断糖尿病的阈值是合理的。
