Glycosylated Haemoglobin (HbA1c) as a Diagnostic Criterion for Hyperglycaemia First Detected in Pregnancy https://doi.org/10.60787/NMJ-64-2-190
Main Article Content
Keywords
Glycosylated Haemoglobin, Diagnostic Criterion, Hyperglycaemia; Pregnancy
Abstract
Background: The study was prompted by the high prevalence of hyperglycaemia first detected in pregnancy (HIP) which is classified into diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM). This study aimed to determine the usefulness of Glycosylated Haemoglobin (HBA1c) in the diagnosis of HIP in the first trimester of pregnancy.
Methodology: The study was of a prospective cross-sectional design carried out between January 2020 and August 2020 at the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH). Three hundred and five consecutive pregnant women attending the antenatal clinic at 8 to 13 +6 weeks of pregnancy were recruited for the study. Patients’ socio-demographic information, anthropometric measurements, and medical, obstetric, and gynaecological history were recorded on a predesigned proforma. Blood was taken for an oral glucose tolerance test (OGTT) and glycosylated haemoglobin (HBA1c) levels. Ethical approval for the study was obtained from the Research Ethics Committee of the UPTH and RSUTH.
Results: The prevalence of DIP, GDM, and HIP in the study was 2.62%, 28.85%, and 31.48% respectively. The ROC curve for HbA1c in the study showed a significant area under the Curve (AUC) value of 0.653%, 95% CI = 0.59 – 0.72, p = 0.001. The Youden index reached 2.50 and the optimal cut-off for HBA1c for diagnosis of diabetes was 5.25%. The sensitivity, specificity, PPV, and NPV for HbA1c against the Gold standard OGTT in the diagnosis of GDM were 36.5%, 88.5%, 59.3, %, and 75.2% respectively. HbA1c had high specificity and moderately high NPV.
Conclusion: Glycosylated haemoglobin was a fairly good tool for diagnosis of HIP in the first trimester, but it could not replace OGTT which is the gold standard.
References
2.Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A1c in the management of diabetes. Journal of diabetes 2009;1:9-17.
3.World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Health Organization; 2013.https://apps.who.int/iris/bitstream/handle/10665/85975/WHO_NMH_MND_13.2_eng.pdf.
4.Holmes VA, Young IS, Patterson CC, Pearson DW, Walker JD, Maresh MJ, et al. Diabetes and Pre-eclampsia Intervention Trial Study Group. Optimal glycaemia control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes; In the diabetes and pre-eclampsia intervention trial. Diabetes care2011;34:1683-1688.
5.Bell R, Glinianaia SV, Tennant PW, Bilous RW, Rankin J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia2012;55:936-947.
6.Anaka O, Houlihan C, Beim R, Ranzini AC. Does first-trimester hemoglobin A1C predict gestational diabetes and fetal outcome? Obstetrics & Gynaecology 2014;123(1):S38-S39.
7.Kilpatrick ES, Bloomgarden ZT, Zimmet PZ. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes: response to the International Expert Committee. Diabetes care2009 Dec;32:e159-1231.
8.Hughes RC, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c ≥ 5.9%(41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care2014;37:2953-2959.
9.Vambergue A, Fajardy I. Consequences of gestational and pregestational diabetes on placental function and birth weight. World journal of diabetes2011; 2:196-203
10.Guerin A, Nisenbaum R, Ray JG. Use of maternal Gamma Hydroxybutyrate (GHb) concentration to estimate the risk of congenital anomalies in the offspring of women with pre-pregnancy diabetes. Diabetes Care2007;30:1920-1925.
11.Muhuza MPU, Zhang L, Wu Q, Qi L, Chen D and Liang Z (2023) The association between maternal HbA1c and adverse outcomes in gestational diabetes. Front. Endocrinol. 14:1105899. doi: 10.3389/fendo.2023.1105899.
12.Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline. DiabeticResearch and clinical practice2014; MID: 24847517.
13.Abbey M, Kasso T. First trimester fasting blood glucose as a screening tool for diabetes mellitus in a teaching hospital setting in Nigeria. Asian Journal of Medicine and Health2018; 10:1-9.
14.Schisterman EF, Perkins N. Confidence Intervals for the Youden Index and Corresponding Optimal Cut-Point. Communications in Statistics—Simulation and Computation2007; 36:549–563.
15.Youden WJ. Index for rating diagnostic tests. Cancer1950; 3:32–35.
16.Chinenye S. Living with diabetes in Nigeria: the cure and prevention.An inaugural lecture series in University of Port Harcourt 2015 October 15. No 126.
17.Chinenye S, Ogu R, Korubo I. Diabetes advocacy and care in Nigeria: A review. TheNigerian Health Journal2015; 15:145–150.
18.Anzaku AS, Musa J. Prevalence and associated risk factors for gestational diabetes in Jos, North-central, Nigeria. Archives of gynecology and Obstetrics2013 May; 287:859-863.
19.Paulo MS, Abdo NM, Bettencourt-Silva R and Al-Rifai RH (2021). Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front. Endocrinol. 12:691033. doi: 10.3389/fendo.2021.691033
20.Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes research and clinical practice 2014;103:176-185.
21.HAPO Study Cooperative Research Group. Hyperglycaemia and adverse pregnancy outcomes. New England Journal of Medicine2008; 358:1991-2002.
22.International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes care2010; 33:676-682.
23.Roura LC, Arulkumaran S. Facing the noncommunicable disease (NCD) global epidemic–the battle of prevention starts in utero–the FIGO challenge. Best Practice & Research Clinical Obstetrics & Gynaecology2015;29:5-14.
24.Francis Sahngun Nahm. Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol2022;75:25-36.
25.Amadi SC, OguRN, Odum E, Ojule J, Enyindah CE, Ugboma HAA. Effectiveness of Glycated Haemoglobin in the Diagnosis of Gestational Diabetes Mellitus among Pregnant Women in Port Harcourt, Nige
26.Benaiges D, Flores-Le Roux JA, Marcelo I, Mañé L, Rodríguez M, Navarro X, et al. Is first-trimester HbA1c useful in the diagnosis of gestational diabetes? Diabetes research and clinical practice2017; 133:85-91.
27.Ryu AJ, Moon HJ, Na JO, Kim YJ, Kim SJ, Mo SI, et al. The usefulness of the glycosylated haemoglobin level for the diagnosis of gestational diabetes mellitus in the Korean population. Diabetes & metabolism journal2015;39:507.
28.Soumya S, Rohilla M, Chopra S, Dutta S, Bhansali A, Parthan G, et al. HbA1c: a useful screening test for gestational diabetes mellitus. Diabetes technology & therapeutics2015;17:899-904.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.