Cohen Nadav, Toledano Yoel, Shafir May, Lavie Ofer, Zilberlicht Ariel
Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Lady Davis Carmel Medical Center, Technion University, 7 Michal Street, 34361, Haifa, Israel.
Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.
Arch Gynecol Obstet. 2024 Dec;310(6):3029-3035. doi: 10.1007/s00404-024-07845-z. Epub 2024 Nov 28.
To assess the postpartum sensitivity and accuracy of serum HbA1c levels, compared to the gold standard of 75-g Oral Glucose Tolerance Test (OGTT), for diagnosis of dysglycemia in patients with a history of gestational diabetes mellitus (GDM).
A nationwide retrospective analysis of individuals with a history of GDM and with records of both postpartum 2 h-OGTT and serum HbA1c measured anytime between delivery until 12 months post-delivery. Results were stratified into 3 different intervals: 0-3 months, 3-12 months, and > 12 months after delivery, according to the timing of both OGTT and HbA1c performance.
Between January 1st, 2015, until December 31st, 2021, a total of 55,119 individuals were screened, and 9,118 were diagnosed with GDM. Overall, 677 of the 9,118 individuals with GDM had laboratory results of both serum HbA1c levels and 2 h 75-gm-OGTT values after delivery. The overall Pearson correlation coefficient between HbA1c and 2 h-OGTT was 0.21 (P < 0.0001). However, when the OGTT results were stratified into 2 h-glucose values ≥ 200 mg/dL, a ROC curve yielded an Area Under the Curve (AUC) of 91.4% [95% CI: 83.9%-98.9%], with HbA1c levels of 5.7% yielding 80.0% sensitivity and 80.8% specificity (95% CI: 44.39-97.48%).
In patients with a recent diagnosis of GDM, serum HbA1c may be used as an auxiliary tool for postpartum diagnosis of dysglycemia.
与75克口服葡萄糖耐量试验（OGTT）这一诊断妊娠期糖尿病（GDM）患者血糖异常的金标准相比，评估产后血清糖化血红蛋白（HbA1c）水平诊断血糖异常的敏感性和准确性。
对有GDM病史且有产后2小时OGTT和分娩至产后12个月期间任何时间测定的血清HbA1c记录的个体进行全国性回顾性分析。根据OGTT和HbA1c检测时间，将结果分为3个不同时间段：产后0 - 3个月、3 - 12个月和>12个月。
2015年1月1日至2021年12月31日期间，共筛查55119人，其中9118人被诊断为GDM。总体而言，9118例GDM患者中有677例在产后有血清HbA1c水平和2小时75克OGTT值的实验室结果。HbA1c与2小时OGTT之间的总体Pearson相关系数为0.21（P < 0.0001）。然而，当将OGTT结果分层为2小时血糖值≥200mg/dL时，ROC曲线的曲线下面积（AUC）为91.4%[95%CI：83.9% - 98.9%]，HbA1c水平为5.7%时，敏感性为80.0%，特异性为80.8%（95%CI：44.39 - 97.48%）。
对于近期诊断为GDM的患者，血清HbA1c可作为产后血糖异常诊断的辅助工具。
