Can we predict GDM in the first trimester?

  • Sci Rep

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Early HbA1c levels may suggest hyperglycemia and increase risk of developing gestational diabetes mellitus (GDM).

Why this matters

  • HbA1c is a measure of glycated hemoglobin, an indicator of glucose control in the prior 3-4 months.
  • Fetal overgrowth may begin before the identification of GDM.

Key results

  • HbA1c was higher in women with GDM throughout pregnancy compared with control participants (P<.03>
  • Both groups followed similar patterns throughout pregnancy: HbA1c decreased slightly from first to second trimesters and tended to increase in the third trimester.
  • There was a linear association between HbA1c at 8-13 weeks' gestation and GDM risk (P=.001).
  • Sensitivity (47%; 95% CI, 34%-60%) and specificity (79%; 95% CI, 62%-88%) of HbA1c at 8-13 weeks' gestation to predict GDM using an HbA1c cutoff of 5.1%.

Study design

  • Secondary analysis of data from a prospective case-control study, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singleton Cohort.
  • Stored blood was used to measure HbA1c at different points during pregnancy to generate longitudinal trajectories of HbA1c across pregnancy.
  • HbA1c compared between control participants (n=211) and women who were diagnosed with GDM (n=100).
  • Funding: The Eunice Kennedy Shriver NICHD.

Limitations

  • Small sample size.

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