Mishra Shalini, Das Vinita, Agrawal Smriti
Faculty of Medical Sciences, King George's Medical University, Lucknow, Uttar Pradesh India.
J Obstet Gynaecol India. 2025 Apr;75(2):160-165. doi: 10.1007/s13224-025-02108-6. Epub 2025 Apr 1.
HbA1c is a biochemical marker to evaluate hyperglycemia status in past 2-3 months. HbA1c ≥ 6.5% is diagnostic criteria for diabetes mellitus according to the American Diabetes Association. Recent studies suggest that anemia alters HbA1c levels, but results are conflicting. This study was planned to understand utility of HbA1c in relation to hemoglobin (Hb) for the diagnosis of gestational diabetes mellitus (GDM) and also to understand if HbA1c can be used as a screening modality for diagnosis of GDM in countries with higher anemia prevalence.
An observational study was conducted on 193 pregnant women of < 16-week gestation attending antenatal OPD of Department of Obstetrics and Gynecology, KGMU, Lucknow, over a period of one year. Blood glucose levels 2 h after ingestion of 75 gm glucose load irrespective of last meal (DIPSI criterion) were determined at 3 antenatal visits along with HbA1c and Hb level and categorized into diabetic and nondiabetic and anemic and non-anemic group. These patients were followed up till delivery to look for various maternal and neonatal outcomes.
A total 416 tests were done for hemoglobin and HbA1c in 193 women. Prevalence of GDM was 32.1%. Cutoff level of HbA1c was 4.8% in our study which also varied according to gestation. Mean HbA1c level found to be higher in anemic compared to non-anemic (4.5 vs. 3.96%) in nondiabetic women. Similar to that in women with GDM, mean HbA1c in anemic women (5.1) was higher compared to non-anemic (4.6) women.
This study clearly shows that mean HbA1c varies across all trimesters; even though in diabetic women, mean HbA1c was higher as compared to nondiabetic, and it showed a statistically significant difference in the presence of anemia. HbA1c showed an inverse correlation with hemoglobin in women with or without GDM. Mean HbA1c level was higher among anemic women in both diabetic and nondiabetic group.
糖化血红蛋白（HbA1c）是评估过去2至3个月高血糖状态的生化指标。根据美国糖尿病协会的标准，HbA1c≥6.5%是糖尿病的诊断标准。近期研究表明贫血会改变HbA1c水平，但结果存在矛盾。本研究旨在了解HbA1c与血红蛋白（Hb）在诊断妊娠期糖尿病（GDM）方面的作用，同时了解在贫血患病率较高的国家，HbA1c是否可作为GDM的筛查手段。
对勒克瑙市KGMU妇产科门诊产前检查的193例妊娠<16周的孕妇进行了为期一年的观察性研究。在3次产前检查时，无论上次进餐情况如何，均测定摄入75克葡萄糖负荷后2小时的血糖水平（DIPSI标准），同时检测HbA1c和Hb水平，并将其分为糖尿病组和非糖尿病组，贫血组和非贫血组。对这些患者进行随访直至分娩，观察各种母婴结局。
对193名女性共进行了416次血红蛋白和HbA1c检测。GDM患病率为32.1%。本研究中HbA1c的临界值为4.8%，且随孕周变化。非糖尿病女性中，贫血者的平均HbA1c水平高于非贫血者（4.5%对3.96%）。与GDM女性相似，贫血GDM女性的平均HbA1c（5.1%）高于非贫血GDM女性（4.6%）。
本研究清楚地表明，平均HbA1c在所有孕期均有变化；尽管糖尿病女性的平均HbA1c高于非糖尿病女性，但在存在贫血时差异有统计学意义。无论有无GDM，女性的HbA1c与血红蛋白呈负相关。糖尿病组和非糖尿病组贫血女性的平均HbA1c水平均较高。
