Glycated haemoglobin in the first trimester: A predictor of gestational diabetes mellitus in pregnant Asian Indian women

Punnose, John; Malhotra, Rajeev; Sukhija, Komal; Mathew, Anu; Sharma, Asha; Choudhary, Naimaa

doi:10.1016/j.diabres.2019.107953

Cited by 22 publications

(23 citation statements)

References 45 publications

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“…Estos resultados coinciden con los obtenidos por Fong et al [20], en los que el 27,3% de las embarazadas con un valor de HbA 1c superior al 5,7%, evaluadas antes de la semana 20 a de gestación desarrollaron DMG. Además, coincide con los resultados de Punnose et al [29] y Walker et al [30], quienes concluyeron que la prueba de HbA 1c ni es superior a las pruebas basadas en la sobrecarga de glucosa, ni resulta rentable. Por lo tanto, la baja AUC de HbA 1c en nuestro estudio, así como en otros [26,29], sugiere que estos puntos de corte extremos podrían no ser adecuados.…”

Section: Discussionunclassified

“…Además, coincide con los resultados de Punnose et al [29] y Walker et al [30], quienes concluyeron que la prueba de HbA 1c ni es superior a las pruebas basadas en la sobrecarga de glucosa, ni resulta rentable. Por lo tanto, la baja AUC de HbA 1c en nuestro estudio, así como en otros [26,29], sugiere que estos puntos de corte extremos podrían no ser adecuados. De acuerdo con otros autores [31][32][33], se propuso un algoritmo combinado.…”

Section: Discussionunclassified

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Mejora del protocolo de cribado de diabetes gestacional: estudio de validación diagnóstica

Rojas¹,

Roger

Grúa³

et al. 2021

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

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Resumen Objetivos El objetivo de este trabajo es evaluar la validez diagnóstica de dos métodos de cribado de diabetes mellitus gestacional (DMG). Métodos Se realizó un estudio prospectivo de validación diagnóstica en 2007 embarazadas. Las participantes fueron asignadas al grupo de alto o bajo riesgo, dependiendo de los factores de riesgo que presentaran. Se realizó una prueba de HbA1c simultáneamente al protocolo estándar basado en el test de O’Sullivan (TOS). Posteriormente, se aplicó un algoritmo que combinaba los resultados de ambos biomarcadores. Resultados En el grupo de bajo riesgo, el TOS mostró un área bajo la curva mayor (AUC 0,953; IC95% 0,915–0,992) que la prueba de HbA1c (0,688; IC 95% 0,541–0,834). El mejor punto de corte del TOS, 153,5 mg/dL (8,52 mmol/L), mostró mayor validez diagnóstica que el de la HbA1c, 28 mmol/mol (4,75%) y que el algoritmo basado en ambas pruebas. En el grupo de alto riesgo, el TOS mostró mejor rendimiento diagnóstico que la HbA1c y el algoritmo. Los puntos de corte óptimos para el TOS fueron mayores que los recomendados en los protocolos actuales. Semana 13: TOS AUC 0,882 (IC 95% 0,843–0,921), HbA1c AUC 0,624 (IC 95% 0,562–0,686), punto de corte para el TOS 140,5 mg/dL (7,8 mmol/L), punto de corte para la HbA1c 33 mmol/mol (5,15%). Semana 24: TOS AUC 0,944 (IC 95% 0,925–0,962), HbA1c AUC 0,642 (IC 95% 0,575–0,709), punto de corte para el TOS, 145,5 mg/dL (8,08 mmol/L), punto de corte para la HbA1c 29 mmol/mol (4,85%). Conclusiones El método para el cribado de DMG basado en el test de O’Sullivan con valores límite superiores a los recomendados fue el que mostró mejor validez diagnóstica. Si se hubieran aplicado estos umbrales, se habría evitado la prueba de sobrecarga oral de glucosa con 100 g al 55,6% y al 13,7% de las gestantes de bajo y alto riesgo.

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Section: Discussionunclassified

Mejora del protocolo de cribado de diabetes gestacional: estudio de validación diagnóstica

Rojas¹,

Roger

Grúa³

et al. 2021

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

View full text Add to dashboard Cite

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“…Early pregnancy sensitivity 1.2%/specificity 99.9% at 5.9% for 24–28/40 GDM (IADPSG) South Asians 14 …”

Section: Current Options For Replacing the Ogttmentioning

confidence: 99%

“…The FBG is particularly problematic in early pregnancy when it drops over time, making threshold definition difficult 12 . The HbA1c is also affected by ethnic differences in glycation and individual variation in red cell turnover 13 and has remarkably low sensitivity for IADPSG‐defined GDM in both early and late pregnancy 14,15 and for adverse pregnancy outcomes (as shown in the HAPO study 16 ).…”

Section: Current Options For Replacing the Ogttmentioning

confidence: 99%

“…Each has attempted to reduce contagion exposure through combining different non‐OGTT testing approaches, which will inevitably reduce the sensitivity of diagnosing GDM. The reliance on the HbA1c, a low sensitivity, high specificity test, is likely to have a particular impact in this regard 12–15 . Conversely, of the women with prior GDM, 30–70% will be commenced on SBGM despite GDM not being present, with resultant increasing costs, diabetes service workload and potentially over‐medicalising some pregnancies 27 …”

Section: Recommendationsmentioning

confidence: 99%

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Options for screening for gestational diabetes mellitus during the SARS‐CoV‐2 pandemic

Simmons

Rudland

Wong

et al. 2020

Aust NZ J Obst Gynaeco

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BACKGROUND During this unprecedented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there has been a growing focus on how to minimise contagion while maintaining excellent clinical care. Non-urgent surgery and routine clinical appointments have been postponed and resources have been diverted to those with possible or diagnosed SARS-CoV-2. Diabetes is a major risk factor for SARS-CoV-2 associated mortality. 1 At the time of writing, unlike with SARS-CoV-1, there was no evidence that pregnant women or their fetuses are more severely affected than the general population if they are infected with SARS-CoV-2. 2 However, given the pandemic only commenced in December 2019, there has been insufficient time to assess the full impact on babies. Neither diagnosed nor undiagnosed gestational diabetes mellitus (GDM) has yet been shown to be associated with either an increased risk of contraction of, or worse outcomes with, SARS-CoV-2. The background risk from infection and of infecting others, particularly those with an already heightened risk, remains a significant concern. As a result, models of GDM antenatal care have largely shifted from group and face-to-face interactions 3 to online and telephone consults. These new approaches, without the interactive interdisciplinary team approach and real-time data

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Maternal metabolic factors and the association with gestational diabetes: A systematic review and meta‐analysis

Habibi

Mousa

Tay

et al. 2022

Diabetes Metabolism Res

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Gestational diabetes (GDM) is associated with several adverse outcomes for the mother and child. Higher levels of individual lipids are associated with risk of GDM and metabolic syndrome (MetS), a clustering of risk factors also increases risk for GDM. Metabolic factors can be modified by diet and lifestyle. This review comprehensively evaluates the association between MetS and its components, measured in early pregnancy, and risk for GDM. Databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, and Cochrane Library) were searched from inception to 5 May 2021. Eligible studies included ≥1 metabolic factor (waist circumference, blood pressure, fasting plasma glucose (FPG), triglycerides, and high-density lipoprotein cholesterol), measured at <16 weeks' gestation. At least two authors independently screened potentially eligible studies. Heterogeneity was quantified using I 2 . Data were pooled by random-effects models and expressed as odds ratio and 95% confidence intervals (CIs). Of 7213 articles identified, 40 unique articles were included in meta-analysis. In analyses adjusting for maternal age and body mass index, GDM was increased with increasing FPG (odds ratios [OR] 1.92; 95% CI 1.39-2.64, k = 7 studies) or having MetS (OR 2.52; 1.65, 3.84, k = 3). Women with overweight (OR 2.17; 95% CI 1.89, 2.50, k = 12) or obesity (OR 4.34; 95% CI 2.79-6.74, k = 9) also were at increased risk for GDM.Early pregnancy assessment of glucose or the MetS, offers a potential opportunity to detect and treat individual risk factors as an approach towards GDM prevention; weight loss for pregnant women with overweight or obesity is not recommended. Systematic review registration: PROSPERO CRD42020199225.

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Glycated haemoglobin in the first trimester: A predictor of gestational diabetes mellitus in pregnant Asian Indian women

Cited by 22 publications

References 45 publications

Mejora del protocolo de cribado de diabetes gestacional: estudio de validación diagnóstica

Mejora del protocolo de cribado de diabetes gestacional: estudio de validación diagnóstica

Options for screening for gestational diabetes mellitus during the SARS‐CoV‐2 pandemic

Maternal metabolic factors and the association with gestational diabetes: A systematic review and meta‐analysis

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