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Hba1c 5.8 During Pregnancy

Monitoring Diabetes Before, During And After Pregnancy

Monitoring Diabetes Before, During And After Pregnancy

View / Download pdf version of this article What is new? All pregnant women should be tested for undiagnosed diabetes using HbA1c prior to 20 weeks’ gestation Pregnant women with HbA1c ≥ 50 mmol/mol should be referred to a diabetes in pregnancy clinic Pregnant women with HbA1c 41 – 49 mmol/mol should be offered lifestyle advice to reduce risks of adverse maternal and fetal outcomes; local protocols may recommend that these women are also referred to a diabetes in pregnancy clinic At 24 to 28 weeks’ gestation, women are recommended to undergo an oral glucose tolerance testing regimen, which is dependent on their initial HbA1c result HbA1c is used to monitor glycaemia postpartum in women who have had gestational diabetes, beginning at three months after birth Pregnancy is a time of significant metabolic change when a woman’s physiology adapts to meet the challenges of gestation. Insulin sensitivity is decreased by as much as 50 to 60% during pregnancy, a level comparable to that seen in people with type 2 diabetes or impaired glucose tolerance.1 This change in insulin sensitivity is thought to be caused by endocrine signals from the growing placenta, and has evolved to aid fetal development.2 During pregnancy the mother’s pancreas typically responds with beta-cell and islet hyperplasia to enable greater insulin production and regulate blood glucose levels.1 Women who do not produce enough insulin to compensate for this transitory increase in insulin resistance develop gestational diabetes. These women often have risk factors for the development of type 2 diabetes and a higher level of insulin resistance before pregnancy.1 After childbirth, the insulin resistance associated with pregnancy usually resolves, as does the need for treatment, if this has been requir Continue reading >>

Hba1c Levels In Patients With Gestational Diabetes Mellitus: Relationship With Pre- Pregnancy Bmi And Pregnancy Outcome

Hba1c Levels In Patients With Gestational Diabetes Mellitus: Relationship With Pre- Pregnancy Bmi And Pregnancy Outcome

Abstract Background/aims: The use of glycated hemoglobin (HbA1c) measurement in gestational diabetes mellitus (GDM) is controversial. Aim of the present study was to determine HbA1c levels in a series of GDM patients, in order to verify the possible contribution of HbA1c to GDM management. Materials/subjects and methods: The study included 148 caucasian GDM patients. GDM screening was performed between the 24th and the 28th week of gestation by a two-step procedure, according to the 4th and 5th International Workshop Conference on Gestational Diabetes Mellitus recommendations. Exclusion criteria were: preexisting diabetes, corticosteroid therapy, history of asthma or hypertension, known fetal anomaly, history of previous stillbirth, preterm delivery considered to be likely for either maternal disease or fetal conditions. HBA1c was determined by a standard HPLC technique. Results: At GDM diagnosis, all HbA1c levels were ≤ 6% and the greatest frequency (71/148; 48.0%) of HbA1c values resulted in the range 5.0-5.3%. This frequency increased to 54% before delivery. A significant correlation between HbA1c values at GDM diagnosis and individual BMI prior to conception was observed. The proportion of pregnancies presenting negative outcomes increased progressively with increasing HbA1c levels, from 6.2% (1/16) for HbA1c levels <5% to 18.3% (13/71) for HbA1c 5.0-5.3%, to 37.8% (17/45) in patients with HBA1c levels 5.4-5.6%, to 56.2% (9/16) for HbA1c levels >5.6%. ROC analysis showed that HbA1c at diagnosis and before delivery resulted a good predictor of adverse pregnancy outcome. Conclusions: The present results indicate that HbA1c levels could be of help in predicting adverse pregnancy events. Discover the world's research 14+ million members 100+ million publications 700k+ Continue reading >>

Universal Hba1c Measurement In Early Pregnancy To Detect Type 2 Diabetes Reduces Ethnic Disparities In Antenatal Diabetes Screening: A Population-based Observational Study

Universal Hba1c Measurement In Early Pregnancy To Detect Type 2 Diabetes Reduces Ethnic Disparities In Antenatal Diabetes Screening: A Population-based Observational Study

Abstract In response to the type 2 diabetes epidemic, measuring HbA1c with the first-antenatal blood screen was recently recommended in NZ. This would enable prompt treatment of women with unrecognised type 2 diabetes, who may otherwise go undetected until the gestational diabetes (GDM) screen. We compare inter-ethnic antenatal screening practices to examine whether the HbA1c test would be accessed by ethnicities most at risk of diabetes, and we determined the prevalence of unrecognised type 2 diabetes and prediabetes in our pregnant population. This is an observational study of pregnancies in Christchurch NZ during 2008–2010. Utilising electronic databases, we matched maternal characteristics to first-antenatal bloods, HbA1c, and GDM screens (glucose challenge tests and oral glucose tolerance tests). Overall uptake of the first-antenatal bloods versus GDM screening was 83.1% and 53.8% respectively in 11,580 pregnancies. GDM screening was lowest in Māori 39.3%, incidence proportion ratio (IPR) 0.77 (0.71, 0.84) compared with Europeans. By including HbA1c with the first-antenatal bloods, the number screened for diabetes increases by 28.5% in Europeans, 40.0% in Māori, 28.1% in Pacific People, and 26.7% in ‘Others’ (majority of Asian descent). The combined prevalence of unrecognised type 2 diabetes and prediabetes by NZ criteria, HbA1c ≥5.9% (41mmol/mol), was 2.1% in Europeans, Māori 4.7% IPR 2.59 (1.71, 3.93), Pacific People 9.5% IPR 4.76 (3.10, 7.30), and ‘Others’ 6.2% IPR 2.99 (2.19, 4.07). Applying these prevalence data to 2013 NZ national births data, routine antenatal HbA1c testing could have identified type 2 diabetes in 0.44% and prediabetes in 3.96% of women. Routine HbA1c measurement in early pregnancy is an ideal screening opportunity, particular Continue reading >>

An Early Pregnancy Hba1c ≥5.9% (41 Mmol/mol) Is Optimal For Detecting Diabetes And Identifies Women At Increased Risk Of Adverse Pregnancy Outcomes

An Early Pregnancy Hba1c ≥5.9% (41 Mmol/mol) Is Optimal For Detecting Diabetes And Identifies Women At Increased Risk Of Adverse Pregnancy Outcomes

OBJECTIVE Pregnant women with undiagnosed diabetes are a high-risk group that may benefit from early intervention. Extrapolating from nonpregnancy data, HbA1c ≥6.5% (48 mmol/mol) is recommended to define diabetes in pregnancy. Our aims were to determine the optimal HbA1c threshold for detecting diabetes in early pregnancy as defined by an early oral glucose tolerance test (OGTT) at <20 weeks’ gestation and to examine pregnancy outcomes relating to this threshold. RESEARCH DESIGN AND METHODS During 2008–2010 in Christchurch, New Zealand, women were offered an HbA1c measurement with their first antenatal bloods. Pregnancy outcome data were collected. A subset completed an early OGTT, and HbA1c performance was assessed using World Health Organization criteria. RESULTS HbA1c was measured at a median 47 days’ gestation in 16,122 women. Of those invited, 974/4,201 (23%) undertook an early OGTT. In this subset, HbA1c ≥5.9% (41 mmol/mol) captured all 15 cases of diabetes, 7 with HbA1c <6.5% (<48 mmol/mol). This HbA1c threshold was also 98.4% (95% CI 97–99.9%) specific for gestational diabetes mellitus (GDM) before 20 weeks (positive predictive value = 52.9%). In the total cohort, excluding women referred for GDM management, women with HbA1c of 5.9–6.4% (41–46 mmol/mol; n = 200) had poorer pregnancy outcomes than those with HbA1c <5.9% (<41 mmol/mol; n = 8,174): relative risk (95% CI) of major congenital anomaly was 2.67 (1.28–5.53), preeclampsia was 2.42 (1.34–4.38), shoulder dystocia was 2.47 (1.05–5.85), and perinatal death was 3.96 (1.54–10.16). CONCLUSIONS HbA1c measurements were readily performed in contrast to the low uptake of early OGTTs. HbA1c ≥5.9% (≥41 mmol/mol) identified all women with diabetes and a group at significantly increased risk Continue reading >>

Hba1c Cutoff Of 5.9% Best For Detecting Diabetes In Pregnancy

Hba1c Cutoff Of 5.9% Best For Detecting Diabetes In Pregnancy

NEW YORK A1c level of 5.9% or higher is optimal for detecting diabetes and for identifying women at increased risk of adverse pregnancy outcomes, according to researchers from New Zealand. This is lower than the currently recommended 6.5% threshold, they note in Diabetes Care, online September 4. "HbA1c is predictive of pregnancy outcomes in women with known diabetes, so we weren't that surprised," Dr. Ruth C. E. Hughes from University of Otago in Christchurch told Reuters Health by email. "However, the rates of adverse pregnancy outcomes were higher than anticipated in women with an HbA1c 5.9%-6.4% (41-46 mmol/mol) who did not meet New Zealand criteria for gestational diabetes on an early pregnancy oral glucose tolerance test." Although several organizations recommend screening for diabetes in pregnancy at the first antenatal visit, the most appropriate test and threshold remain undefined. Dr. Hughes's team studied a prospective cohort study of more than 16,100 pregnant women, who had blood drawn at a median 47 days' gestation. The mean HbA1c among all women tested was 5.3%. Only 33 women (0.2%) had HbA1c of 6.5% or higher. Of the 974 women who had oral glucose tolerance tests (OGTTs) before 20 weeks' gestation, 15 met criteria for diabetes (median HbA1c, 6.5%) and 170 for gestational diabetes (GDM) (median HbA1c, 5.8%). On receiver operating curve (ROC) analysis, an HbA1c of 5.9% emerged as the optimal screening threshold for detecting diabetes. It yielded 100% sensitivity, 97.4% specificity, 18.8% positive predictive value, and 100% negative predictive value. The 5.9% cutoff was also highly specific (98.4%) for early GDM, with a positive predictive value of 52.9% and a negative predictive value of 92.8%. About three-quarters of women with early HbA1c of 5.9% or highe Continue reading >>

Ultimate Guide To The A1c Test: Everything You Need To Know

Ultimate Guide To The A1c Test: Everything You Need To Know

The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. The A1c goes by several different names, such aswa Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. What is Hemoglobin? Hemoglobin is a protein in your blood cells that carries oxygen. When sugar is in the blood, and it hangs around for a while, it starts to attach to the red blood cells. The A1C test is a measurement of how many red blood cells have sugar attached. So, if your A1C result is 7%, that means that 7% of your red blood cells have sugar attached to them. What are the Symptoms of a High A1C Test Level? Sometimes there are NO symptoms! That is probably one of the scariest things about diabetes, your sugar can be high for a while and you may not even know it. When your blood sugar goes high and stays high for longer periods of time you may notice the following: tired, low energy, particularly after meals feel very thirsty you may be peeing more than normal, waking a lot in the middle of the night to go dry, itchy skin unexplained weight loss crave sugar, hungrier than normal blurred vision, may feel like you need new glasses tingling in feet or hands cuts or sores take a long time to heal or don’t heal well at all frequent infections (urinary tract, yeast infections, etc.) When your blood sugar is high, this means the energy that you are giving your body isn’t getting into the cells. Think about a car that has a gas leak. You put gas in, but if the gas can’t get to the engine, the car will not go. When you eat, some of the food is broken down into sugar and goes into your bloodstream. If your body can’t get the sugar to the cells, then your body can’t “go.” Some of the sugar tha Continue reading >>

High Hb1ac And Pregnancy Outcomes - Your Stories Please

High Hb1ac And Pregnancy Outcomes - Your Stories Please

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community High HB1ac and pregnancy outcomes - your stories please Discussion in ' Pregnancy ' started by Worried123 , Aug 30, 2013 . I am new to this forum - I am currently 15 weeks pregnant, 38 years of age. Been trying for years and I had almost given up hope and had become complacent with my folic acid and diabetes management. My local hospital - due to staff shortages - cancelled all my pre-pregnancy appointments. Consequently, I concieved on a relatively high HB1ac of 8.3. Understandably very concerned about congenital abnormalities which occur in the first weeks following conception. I found out I was pregnant when I was at 4 weeks. Luckily I had started taking folic acid a few weeks before I found out I was pregnant so at a best guess I was on folic acid - high dose for about 2 weeks before conceiving. I know NHS recommends a month or even 3 months pre-conception but .... I would be very very grateful to hear from anyone who has conceived on similar or higher HB1ac and the outcome of the pregnancy - meaning was the baby OK or were congenital problems identified before or after birth? My biggest concern is spine damage which is increased significantly in women with poorly controlled diabetes at conception. So far I have had several scans. I understand that in the 12/13 week scan abnormalities in skull size/shape and organs such as bowel and bladder are reliably used to diagnose neural tube/spine defects. However nothing has been mentioned to me so far and I have been informed that all looks normal. I have an early anamoly scan at 17 weeks (private scan) and another at 19.5 weeks (nhs scan) but very anxious. I have searced online and the only stories I hav Continue reading >>

Indicators Of Glycemic Control In Patients With Gestational Diabetes Mellitus And Pregnant Women With Diabetes Mellitus

Indicators Of Glycemic Control In Patients With Gestational Diabetes Mellitus And Pregnant Women With Diabetes Mellitus

Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus Number of Hits and Downloads for This Article Jul 25, 2015 (publication date) through Apr 23, 2018 Baishideng Publishing Group Inc, 7901 Stoneridge Drive, Suite 501, Pleasanton, CA 94588, USA Copyright The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. World J Diabetes.Jul 25, 2015;6(8): 1045-1056 Published online Jul 25, 2015.doi: 10.4239/wjd.v6.i8.1045 Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus Kunihiko Hashimoto, Department of Internal Medicine, NTT West Osaka Hospital, Osaka 543-8922, Japan Masafumi Koga, Department of Internal Medicine, Kawanishi City Hospital, Kawanishi, Hyogo 654-8533, Japan Author contributions: Hashimoto K wrote the first draft of the manuscript; Koga M edited and supervised the writing of the manuscript. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Correspondence to: Masafumi Koga, MD, PhD, Department of Internal Medicine, Kawanishi City Hospital, Kawanishi, Hyogo 664-8533, Japan. Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternal-infant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus (G Continue reading >>

Early Prediabetes Treatment Reduces Hba1c During Pregnancy

Early Prediabetes Treatment Reduces Hba1c During Pregnancy

Early prediabetes treatment reduces HbA1C during pregnancy SAN DIEGO Early treatment of pregnant women with prediabetes led to lower hemoglobin A1C (HbA1C) levels during the second trimester and at delivery in a randomized, controlled trial. Study subjects were 83 women with a first trimester HbA1C of 5.7%-6.4% (median of 5.8%) indicative of prediabetes. HbA1C levels during the second trimester were 5.2% and 5.3% in the 42 women who were randomized to receive early treatment and in the 41 who received routine care, respectively, and the levels at delivery were 5.5% and 5.8%, respectively, Dr. Sarah Osmundson reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine. The overall rate of positive glucose tolerance tests (GTT) or insulin use prior to the GTT the primary study outcome did not differ significantly between the groups but did trend toward lower in the early treatment group (45.2% vs. 55%; relative risk, 0.82), said Dr. Osmundson of Stanford (Calif.) University. Further, although no difference was seen in the rate of gestational diabetes mellitus (GDM) among women with prepregnancy obesity in the early treatment and routine care groups, early treatment was associated with a 50% lower rate of GDM in nonobese women (29.6% vs. 59.1%, relative risk, 0.50), she said. The participants had a singleton pregnancy, no chronic steroid use, and no preexisting diabetes. They were enrolled between May 2012 and June 2014, and all met with a certified diabetes educator at study entry to discuss healthy weight gain strategies in pregnancy and to set personalized weight gain goals. Those in the early treatment group also were counseled to keep a diary to track food intake, were advised to monitor portion size, and limit carbohydrate intake to Continue reading >>

Hemoglobin A1c As Screening For Gestational Diabetes Mellitus In Nordic Caucasian Women

Hemoglobin A1c As Screening For Gestational Diabetes Mellitus In Nordic Caucasian Women

Abstract Background Gestational diabetes mellitus (GDM) increases the risk for preeclampsia and macrosomia. GDM is conventionally diagnosed by an oral glucose tolerance test (OGTT). Hemoglobin A1c (HbA1c) is a marker for the average glucose level the last 2–3 months. We aimed to study if HbA1c alone or in combination with patient characteristics can be used to screen for GDM and reduce the number of OGTTs, and whether it could predict preeclampsia or birth weight. Methods 855 women from a previous study on the effect of exercise on GDM prevalence were eligible, whereof 677 were included. GDM was diagnosed by WHO 1999 criteria (GDM-WHO) and modified IADPSG criteria (GDM-IADPSG), at pregnancy weeks 18–22 and 32–36. HbA1c analyzed at pregnancy weeks 18–22 and 32–36, variables from patient history and clinical examination were considered for logistic regression models. The diagnostic accuracy was assessed by ROC curve analysis. Accumulated GDM prevalence was 6.7 % by WHO and 7.2 % by modified IADPSG criteria. Nearly a third could potentially have avoided an OGTT by using HbA1c to exclude GDM-IADPSG with a sensitivity of 88 % at week 18–22 and 97 % at week 32–36. Further, 16 % could have avoided an OGTT with a sensitivity of 96 % using HbA1c at week 18–22 to exclude GDM-IADPSG throughout pregnancy. HbA1c was not accurate at diagnosing GDM-IADPSG, and it was inaccurate at screening for GDM-WHO at any time point. Adding other predictors did not increase the number of potentially avoidable OGTTs significantly. HbA1c was not significantly associated with preeclampsia or birth weight. Background Women with gestational diabetes mellitus (GDM) have an increased risk of obstetrical complications and adverse pregnancy outcomes such as preeclampsia and macrosomia [1]. Continue reading >>

Glycosylated Hemoglobin Values In Nondiabetic Pregnant Women In The Third Trimester And Adverse Fetal Outcomes: An Observational Study

Glycosylated Hemoglobin Values In Nondiabetic Pregnant Women In The Third Trimester And Adverse Fetal Outcomes: An Observational Study

Glycosylated hemoglobin values in nondiabetic pregnant women in the third trimester and adverse fetal outcomes: An observational study 1Lakeshore Hospital and Research Centre, Kochi, Kerala, India Address for correspondence: Dr. P. Shobha, Kappillil Sanjeevani, Residents Lane, Edappally P.O., Kochi - 682 024, Kerala, India. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : Journal of Family Medicine and Primary Care This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. The objective of the study is to estimate the level of glycosylated hemoglobin (HbA1c) for a safe fetal outcome and to estimate the relation between this level and various adverse fetal outcomes. Materials and Primigravidas who are diagnosed as not having gestational diabetes mellitus as per the glucose challenge test done at 24 weeks with a cutoff value up to 140 mg/dl are followed up at 3034 weeks for the estimation of HbA1c in the blood and further till the time of delivery and postnatal period for the fetal outcomes. Data were collected based on detailed patient interview, clinical examination, and laboratory investigations. Data were analyzed to obtain the mean value of HbA1c in the third trimester. Fetal outcomes were analyzed with the HbA1c value using Chi-square test. The HbA1c values in the third trimester of pregnancy in this study ranged from 4.5% to 6%. Unfavorable outcomes were found the least in the 4.5%5%. The average plasma blood glucose corresponding to HbA1c value of 5% is 101 mg/dl. Continue reading >>

Hemoglobin A1c Test (hba1c, A1c, Hb1c)

Hemoglobin A1c Test (hba1c, A1c, Hb1c)

Hemoglobin A1c definition and facts Hemoglobin A1c is a protein on the surface of red blood cells that sugar molecules stick to, usually for the life of the red blood cell (about three months). The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells. Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time period. Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes. Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%. Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control. Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c. To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives us an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which gl Continue reading >>

Hba1c And Pregnancy

Hba1c And Pregnancy

Tweet Keeping blood sugar levels under control is hugely important for women who either have diabetes going into pregnancy or who develop diabetes during their pregnancy. Tight blood glucose control helps increase the chances of a successful pregnancy by cutting the risk of complications for your baby. If you have diabetes, one of the ways your doctor or nurse will monitor your glycemic control is by carrying out a HbA1c test. The HbA1c test measures glycated haemoglobin - a molecule within red blood cells that naturally bonds with glucose - to get a good indication of your average blood glucose over the past 8-12 weeks. This guide outlines when your HbA1c readings will be taken and what HbA1c values should be before (planning stage), during and after your pregnancy. Planning pregnancy The NICE guidelines for Diabetes in Pregnancy (Clinical Guideline 63) state that women with diabetes should aim to achieve an HbA1c result of 43 mmol/mol (6.1%) or lower. If you are planning to become pregnant, you should be offered an HbA1c measurement on a monthly basis to help monitor your blood glucose control. Meeting the target will help to minimise the risk of the baby developing risk of congenital malformations. If you have an HbA1c above 10%, it is strongly advised to avoid becoming pregnant until good diabetes control is achieved and sustained. During pregnancy During the first trimester of pregnancy, the HbA1c target for women with diabetes is the same as for planning a pregnancy, that is 43 mmol/mol (6.1%) or lower. During the second and third trimesters of pregnancy, from week 13 onwards, HbA1c should not be used for assessing blood glucose control. Throughout pregnancy, women with diabetes should aim to meet the following blood glucose targets Before meals: 3.5 to 5.9 mmol/l Continue reading >>

Original Research Hba1c As A Predictor Of Diabetes After Gestational Diabetes Mellitus

Original Research Hba1c As A Predictor Of Diabetes After Gestational Diabetes Mellitus

Highlights • Third-trimester HbA1c was investigated as a predictor of diabetes following GDM. • After five years, 73/196 (37%) of the women had developed diabetes. • HbA1c ≥36 mmol/mol (≥5.4%) was associated with a 5.5-fold increased risk of diabetes. • HbA1c showed high specificity but low sensitivity to predict diabetes post-partum. • HbA1c could be used as a means of selecting high-risk women for interventions. Abstract We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM. Continue reading >>

Hba1c Cutoff Of 5.9% Best For Detecting Diabetes In Pregnancy

Hba1c Cutoff Of 5.9% Best For Detecting Diabetes In Pregnancy

HbA1c Cutoff of 5.9% Best for Detecting Diabetes in Pregnancy NEW YORK - A hemoglobin (Hb) A1c level of 5.9% or higher is optimal for detecting diabetes and for identifying women at increased risk of adverse pregnancy outcomes, according to researchers from New Zealand. This is lower than the currently recommended 6.5% threshold, they note in Diabetes Care, online September 4. "HbA1c is predictive of pregnancy outcomes in women with known diabetes, so we weren't that surprised," Dr. Ruth C. E. Hughes from University of Otago in Christchurch told Reuters Health by email. "However, the rates of adverse pregnancy outcomes were higher than anticipated in women with an HbA1c 5.9%-6.4% (41-46 mmol/mol) who did not meet New Zealand criteria for gestational diabetes on an early pregnancy oral glucose tolerance test." Although several organizations recommend screening for diabetes in pregnancy at the first antenatal visit, the most appropriate test and threshold remain undefined. Dr. Hughes's team studied a prospective cohort study of more than 16,100 pregnant women, who had blood drawn at a median 47 days' gestation. The mean HbA1c among all women tested was 5.3%. Only 33 women (0.2%) had HbA1c of 6.5% or higher. Of the 974 women who had oral glucose tolerance tests (OGTTs) before 20 weeks' gestation, 15 met criteria for diabetes (median HbA1c, 6.5%) and 170 for gestational diabetes (GDM) (median HbA1c, 5.8%). On receiver operating curve (ROC) analysis, an HbA1c of 5.9% emerged as the optimal screening threshold for detecting diabetes. It yielded 100% sensitivity, 97.4% specificity, 18.8% positive predictive value, and 100% negative predictive value. The 5.9% cutoff was also highly specific (98.4%) for early GDM, with a positive predictive value of 52.9% and a negative predict Continue reading >>

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