Early Gestational Diabetes Mellitus Screening With Glycated Hemoglobin: A Systematic Review

Abstract Background We conducted a systematic review and meta-analysis to establish the overall accuracy of glycated hemoglobin (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM) diagnosis. Methods We searched MEDLINE, EMBASE, SCOPUS and ClinicalTrials.gov up to October 2018, using keywords related to GDM, HbA1c and diagnosis. Studies were included that were carried out with pregnant women without previous diabetes that assessed the performance of HbA1c (index test) compared to the 75 g oral glucose tolerance test (OGTT) (reference test) for the diagnosis of GDM, that measured HbA1c by standardized methods and presented data necessary for drawing 2 × 2 tables. Results This meta-analysis included eight studies, totaling 6406 pregnant women, of those 1044 had GDM. The diagnostic accuracy of HbA1c was reported at different thresholds ranging from 5.4% (36 mmol/mol) to 6.0% (42 mmol/mol), and the area under the curve (AUC) was 0.825 (95% confidence interval [CI] 0.751–0.899), indicating a good level of overall accuracy. The pooled sensitivities and specificities were 50.3% (95% CI 24.8%–75.7%) and 83.7% (67.5%–92.7%); 24.7% (10.3%–48.5%) and 95.5% (85.7%–98.7%); 10.8% (5.7%–19.41%) and 98.7% (96.2%–99.5%); 12.9% (5.5%–27.5%) and 98.7% (97.6%–99.3%), for the cut-offs of 5.4% (36 mmol/mol), 5.7% (39 mmol/mol), 5.8% (40 mmol/mol) and 6.0% (42 mmol/mol), respectively. Conclusions We observed a high heterogeneity among the studies. The effect of ethnicities, different criteria for OGTT interpretation and the individual performance of HbA1c methods may have contributed to this heterogeneity. The HbA1c test presents high specificity but low sensitivity regardless of the threshold used to diagnose GDM. These findings point to the usefulness of HbA1c as a rule-in test. HbA1c should be used in association with other standard diagnostic tests for GDM diagnosis.

Download Full-text

First Trimester Glycated Hemoglobin (HBA1C) Level as a Novel Predictor of Gestational Diabetes Mellitus: a Systematic Review and Meta-Analysis

Journal of Asian Medical Students' Association ◽

10.52629/jamsa.v9i1.260 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ayers Gilberth Ivano Kalaij ◽

Nathaniel Gilbert Dyson ◽

Michael Sugiyanto

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Cohort Studies ◽

Hba1c Level ◽

Glycated Hemoglobin ◽

Meta Analysis ◽

Significant Risk ◽

First Trimester

Introduction: Gestational diabetes mellitus (GDM) is a severe yet neglected threat to maternal and child health, due to its association with multiple adverse pregnancy outcomes. glycated hemoglobin (HbA1c) level is one of the most promising predictor of GDM in early pregnancy based on several cohort studies done recently. Purpose of study: This systematic review and meta-analysis aims to evaluate the potency of HbA1c level in first trimester as a novel predictor of GDM. Methods: This review selects cohort studies found by database searching systematically using previously determined inclusion, such as pregnant woman as the subject, assess Hb1Ac level in the first trimester, and assess odds ratio towards (GDM), and exclusion criteria such as assess outcome at postpartum, not assess GDM outcomes, and studies written in languages other than English or Bahasa Indonesia. This review was arranged based on PRISMA guideline. Results and Discussion: This review included seven cohort studies with the pooled OR of 4.36 [95%CI: 3.66-5.20]. Quantitative analysis shows that HbA1c level in the first trimester is a significant risk factor of GDM development (p<0.00001). However, heterogeneity analyses revealed substantial heterogeneity are detected in the pooled studies. Therefore, to understand the significance of HbA1c level and the development of GDM, further studies are needed. Conclusion: This study has proven the potency of first trimester HbA1c level as a novel predictor of gestational diabetes mellitus. Thus, it is necessary to integrate the use of HbA1c level screening as part of antenatal care in the first trimester of pregnancy.

Download Full-text