Perinatal center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan.
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Obstet Gynaecol Res. 2024 Dec;50(12):2211-2217. doi: 10.1111/jog.16108. Epub 2024 Oct 10.
To verify whether hemoglobin A1c (HbA1c) levels in early pregnancy can predict the diagnosis of gestational diabetes mellitus (GDM) in mid-pregnancy.
This was a retrospective cohort study of 2008 pregnant women who delivered singletons at the Yokohama City university Medical Center. Concomitant or history of diabetes mellitus and overt diabetes in pregnancy were excluded. Pregnant women at high risk for GDM underwent a one-step 75-g oral glucose tolerance test (OGTT) during mid-pregnancy. For other pregnant women, GDM was diagnosed by a two-step 75-g oral glucose tolerance test (OGTT) when the 50-g glucose challenge test result in mid-pregnancy was ≥140 mg/dL. The thresholds for 75-g OGTT followed those of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria (92-180-153 mg/dL). The relationship between HbA1c level measured at <20 weeks of gestation and GDM diagnosis at mid pregnancy was assessed using a receiver operating characteristic curve (ROC); area under the curve (AUC) and optimal cutoff value of HbA1c, predictive of GDM were calculated.
The median HbA1c level at <20 weeks of gestation was 5.3%, and 8.5% of women were diagnosed with GDM. In the ROC curve of the GDM diagnosis rate by HbA1c level, AUC was 0.706, and the optimal cutoff value was 5.4%, with a sensitivity of 0.6176, specificity of 0.6834, positive predictive value of 15.4%, and negative predictive value of 95.1%.
Although HbA1c at less than 20 weeks of gestation is acceptable discrimination as a diagnostic tool of GDM in mid-pregnancy, it is not clinically useful to predict GDM in mid-pregnancy.
验证孕早期糖化血红蛋白（HbA1c）水平能否预测中期妊娠时妊娠期糖尿病（GDM）的诊断。
这是一项回顾性队列研究，共纳入了 2008 名在横滨市立大学医疗中心分娩单胎的孕妇。排除了同时或既往患有糖尿病以及妊娠显性糖尿病的孕妇。GDM 高危孕妇在孕中期行一步法 75g 口服葡萄糖耐量试验（OGTT）。对于其他孕妇，当孕中期 50g 葡萄糖筛查试验结果≥140mg/dL 时，行二步法 75g 口服葡萄糖耐量试验（OGTT）诊断 GDM。75g OGTT 的阈值遵循国际妊娠糖尿病研究协会（IADPSG）标准（92-180-153mg/dL）。采用受试者工作特征曲线（ROC）评估孕 20 周前测定的 HbA1c 水平与中期妊娠 GDM 诊断之间的关系；计算预测 GDM 的 HbA1c 曲线下面积（AUC）和最佳截断值。
孕 20 周前测定的 HbA1c 中位数为 5.3%，8.5%的孕妇被诊断为 GDM。在 HbA1c 水平预测 GDM 诊断率的 ROC 曲线中，AUC 为 0.706，最佳截断值为 5.4%，其敏感性为 0.6176，特异性为 0.6834，阳性预测值为 15.4%，阴性预测值为 95.1%。
尽管孕 20 周前的 HbA1c 可作为中期妊娠 GDM 的诊断工具，但对预测中期妊娠 GDM 无临床应用价值。
