Hemoglobin A1c in early postpartum screening of women with gestational diabetes

Abstract

HbA1c level ≥ 48 mmol/mol (≥ 6.5%) has reasonable sensitivity and high specificity in comparison to OGTT for early postpartum screening of diabetes in GDM. At 6(th) week postpartum screening, if FBG is normal and HbA1c < 44 mmol/mol OGTT is not recommended.

Role of HbA1c in post-partum screening of women with gestational diabetes mellitus

“…In contrast, Katreddy et al. reported a sensitivity of 71% and a specificity of 99% (AUC 0.98) in the diagnosis of diabetes, although the sensitivity of HbA1c ≥6.0% (≥42 mmol/mol) for detecting abnormal glucose tolerance was low (28%) [20] . Another study by Kim et al., based on a small group of women who had had GDM, found a sensitivity 65% and a specificity 68% for HbA1c ≥ 5.7% (≥39 mmol/mol) in detection of abnormal glucose tolerance [21] .…”

“…Easy, cost-effective, and less time-consuming screening strategies are required to capture as many women as possible who are at risk of type-2 diabetes. In this context, the HbA1c test appears to be attractive and its validity as a screening tool for abnormal glucose metabolism after GDM has only been examined in a few studies, with somewhat conflicting results 17 , 19 , 20 , 21 , 22 .…”

Diagnostic value of haemoglobin A1c in post‐partum screening of women with gestational diabetes mellitus

“…Although HbA 1c is not currently recommended for the screening of glucose intolerance in post‐partum women with GDM, several studies have evaluated HbA 1c as a screening test for undiagnosed pre‐diabetes or diabetes . Some authors have suggested that HbA 1c ≥ 48 mmol/mol (6.5%) had reasonable sensitivity (71.4%) and high specificity (98.5%) for early post‐partum screening of diabetes in 203 women with GDM at 6 weeks post‐partum . In another study conducted between 6 weeks and 36 months post‐partum, HbA 1c ≥ 39 mmol/mol (5.7%) had 65% sensitivity and 68% specificity for identifying abnormal glucose tolerance in 54 women with histories of GDM .…”

“…HbA 1c has several advantages over fasting plasma glucose (FPG) and OGTT, including greater convenience (fasting not required), greater pre‐analytical stability and fewer day‐to‐day variations due to stress and illness . Several studies have suggested that using HbA 1c might improve the post‐partum testing rate for women with GDM . However, the usefulness of HbA 1c for the reassessment of glycaemic status in post‐partum women with a history of GDM remains controversial because, in previous studies, post‐partum evaluations have been performed at various times from 6 weeks to 3 years .…”

Maternal Gestational Diabetes and Fetal Congenital Heart Disease: An Observational Study

“…There may be benefits from screening at risk women for diabetes before they conceive.In recent years the WHO have advised that a glycated haemoglobin A1c (HbA1c) level can be measured to diagnose diabetes, replacing the oral glucose tolerance (OGT) test which takes 2 hours and requires the patient to fast. One of the advantages of the HbA1c is it can be taken with routine bloods and a level above 6.5% confirms the diagnosis of diabetes [39,40]. Could this be a quick screening tool?…”