Jaja Merry Alali, Mkpe Abbey, Amadi Simeon Chijioke, Kasso Tehemen, Allison Frederick, Oloyede Olufemi Adebari, Nonye-Enyidah Esther, Okagua Kenneth, Kwosah Ngozi Joseph, Kua Paul, Iwo-Amah Rose Sitonma, Mba Alpheaus Gogo, Ocheche Uduak S, Altraide Basil Omieibi, Sapira-Ordu Leesi, John Dickson Hezekiah, Okocha Ada Nkemagu, Innimgba Nestor, Akani Christian Ihenachor
Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Niger Med J. 2023 May 11;64(2):281-292. eCollection 2023 Mar-Apr.
The study was prompted by the high prevalence of hyperglycaemia first detected in pregnancy (HIP) which is classified into diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM). This study aimed to determine the usefulness of Glycosylated Haemoglobin (HBA1c) in the diagnosis of HIP in the first trimester of pregnancy.
The study was of a prospective cross-sectional design carried out between January 2020 and August 2020 at the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH). Three hundred and five consecutive pregnant women attending the antenatal clinic at 8 to 13 weeks of pregnancy were recruited for the study. Patients' socio-demographic information, anthropometric measurements, and medical, obstetric, and gynaecological history were recorded on a predesigned proforma. Blood was taken for an oral glucose tolerance test (OGTT) and glycosylated haemoglobin (HBA1c) levels. Ethical approval for the study was obtained from the Research Ethics Committee of the UPTH and RSUTH.
The prevalence of DIP, GDM, and HIP in the study was 2.62%, 28.85%, and 31.48% respectively. The ROC curve for HbA1c in the study showed a significant area under the Curve (AUC) value of 0.653%, 95% CI = 0.59 - 0.72, p = 0.001. The Youden index reached 2.50 and the optimal cut-off for HBA1c for diagnosis of diabetes was 5.25%. The sensitivity, specificity, PPV, and NPV for HbA1c against the Gold standard OGTT in the diagnosis of GDM were 36.5%, 88.5%, 59.3, %, and 75.2% respectively. HbA1c had high specificity and moderately high NPV.
Glycosylated haemoglobin was a fairly good tool for diagnosis of HIP in the first trimester, but it could not replace OGTT which is the gold standard.
本研究受首次在孕期检测到的高血糖症（HIP）的高患病率所推动，HIP分为妊娠期糖尿病（DIP）和妊娠期糖尿病（GDM）。本研究旨在确定糖化血红蛋白（HBA1c）在孕早期诊断HIP中的作用。
本研究采用前瞻性横断面设计，于2020年1月至2020年8月在哈科特港大学教学医院（UPTH）和里弗斯州立大学教学医院（RSUTH）进行。招募了305名怀孕8至13周在产前诊所就诊的连续孕妇参与研究。患者的社会人口统计学信息、人体测量数据以及医疗、产科和妇科病史被记录在预先设计的表格上。采集血液进行口服葡萄糖耐量试验（OGTT）和糖化血红蛋白（HBA1c）水平检测。本研究获得了UPTH和RSUTH研究伦理委员会的伦理批准。
本研究中DIP、GDM和HIP的患病率分别为2.62%、28.85%和31.48%。研究中HbA1c的ROC曲线显示曲线下面积（AUC）值显著为0.653%，95%置信区间=0.59 - 0.72，p = 0.001。约登指数达到2.50，诊断糖尿病的HBA1c最佳截断值为5.25%。在诊断GDM时，HbA1c相对于金标准OGTT的敏感性、特异性、阳性预测值和阴性预测值分别为36.5%、88.5%、59.3%和75.2%。HbA1c具有高特异性和中等偏高的阴性预测值。
糖化血红蛋白是孕早期诊断HIP的相当好的工具，但它不能替代作为金标准的OGTT。
