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Use of oral glucose tolerance testing and HbA1c at 6–14 gestational weeks to predict gestational diabetes mellitus in high-risk women

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Purpose To study the prediction of gestational diabetes mellitus (GDM) in high-risk pregnant women by testing fasting blood glucose, 1-h(1hPG) and 2-h plasma glucose (2hPG) after an oral glucose tolerance test, and glycated hemoglobin (HbA1c) in early pregnancy (6–14 weeks). Methods We recruited 1311 pregnant women at high risk for diabetes from the Obstetrics Clinic of Daxing District People’s Hospital between June 2017 and December 2019. The tests performed during the first trimester included fasting blood glucose (FPG), HbA1c, and 75-g oral glucose tolerance test (OGTT) with 1hPG and 2hPG. Seventy-three pregnant women diagnosed with pregestational diabetes mellitus (PGDM) early in pregnancy and 36 who were missed in the second trimester were excluded. A total of 1202 women were followed up until 24–28 weeks for GDM. The receiver operating characteristic (ROC) and area under the ROC curve (AUC) were calculated to determine the predictive values of FPG, 1hPG, 2hPG, and HbA1c for GDM in early pregnancy in high-risk pregnant women. Results The AUC for 1hPG for the prediction of GDM in high-risk pregnant women was greater than those for FPG, 2hPG, and HbA1c. All differences were significant. The AUCs for the predictive values of FPG, 1hPG, 2hPG, and HbA1c in high-risk pregnant women were 0.63, 0.76, 0.71, and 0.67, respectively. The prevalence of PGDM among pregnant women at high risk of diabetes was 5.6%. Conclusion First-trimester levels of FPG, 1hPG, 2hPG, and HbA1c in high-risk women are significant predictors of GDM, with 1hPG having the most significant predictive value.
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Archives of Gynecology and Obstetrics
https://doi.org/10.1007/s00404-022-06637-7
MATERNAL-FETAL MEDICINE
Use oforal glucose tolerance testing andHbA1c at6–14 gestational
weeks topredict gestational diabetes mellitus inhigh‑risk women
XiaoxiaoPeng1· MingyiLiu1· JunGang1· YingWang1· XiuhuaMa1
Received: 11 December 2021 / Accepted: 17 May 2022
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022
Abstract
Purpose To study the prediction of gestational diabetes mellitus (GDM) in high-risk pregnant women by testing fasting
blood glucose, 1-h(1hPG) and 2-h plasma glucose (2hPG) after an oral glucose tolerance test, and glycated hemoglobin
(HbA1c) in early pregnancy (6–14weeks).
Methods We recruited 1311 pregnant women at high risk for diabetes from the Obstetrics Clinic of Daxing District Peo-
ple’s Hospital between June 2017 and December 2019. The tests performed during the first trimester included fasting blood
glucose (FPG), HbA1c, and 75-g oral glucose tolerance test (OGTT) with 1hPG and 2hPG. Seventy-three pregnant women
diagnosed with pregestational diabetes mellitus (PGDM) early in pregnancy and 36 who were missed in the second trimester
were excluded. A total of 1202 women were followed up until 24–28weeks for GDM. The receiver operating characteristic
(ROC) and area under the ROC curve (AUC) were calculated to determine the predictive values of FPG, 1hPG, 2hPG, and
HbA1c for GDM in early pregnancy in high-risk pregnant women.
Results The AUC for 1hPG for the prediction of GDM in high-risk pregnant women was greater than those for FPG, 2hPG,
and HbA1c. All differences were significant.
The AUCs for the predictive values of FPG, 1hPG, 2hPG, and HbA1c in high-risk pregnant women were 0.63, 0.76, 0.71,
and 0.67, respectively. The prevalence of PGDM among pregnant women at high risk of diabetes was 5.6%.
Conclusion First-trimester levels of FPG, 1hPG, 2hPG, and HbA1c in high-risk women are significant predictors of GDM,
with 1hPG having the most significant predictive value.
Keywords First-trimester pregnancy· Gestational diabetes mellitus (GDM)· High-risk pregnant women· Glucose
tolerance test (OGTT)· ROC curve
Introduction
Gestational diabetes mellitus (GDM) is the most common
complication in pregnancy. GDM increases the risk of other
complications, such as preeclampsia, cesarean section,
fetal overgrowth, shoulder dystocia, neonatal hypoglyce-
mia, and neonatal admission to intensive care [1, 2]. It also
increases the risk of obesity and abnormal glucose metabo-
lism in the offspring [35]. Currently, GDM is diagnosed
at 24–28weeks of gestation according to the diagnostic
criteria recommended by the International Gestational Dia-
betes Research Group [6]. However, some pregnant women
have high blood sugar in the early stages of pregnancy due
to a missed diagnosis of pregestational diabetes mellitus
(PGDM), which has a high prevalence in China [7, 8]. Early
screening for GDM is recommended for pregnant women
with risk factors to improve pregnancy outcomes [914].
* Xiuhua Ma
dxqrmyy123@163.com
Xiaoxiao Peng
1156590597@qq.com
Mingyi Liu
786699618@qq.com
Jun Gang
gangzilan@aliyun.com
Ying Wang
onlyyingzi66@163.com
1 Daxing District People’s Hospital, Beijing102600,
People’sRepublicofChina
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