The online version of this article (doi:10.1186/s12902-015-0039-9) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
IHO performed the statistical analyses, interpreted the data and drafted the manuscript. AÅ contributed to the statistical analyses, interpretation of the data and revised the manuscript critically before submission. EV and SMC made substantial contributions to the conception and design of the randomised, multicenter study. They revised the manuscript critically before submission. All authors read and approved the final manuscript.
Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes such as preeclampsia and macrosomia. Women with polycystic ovary syndrome (PCOS) are at increased risk of developing GDM. Today, GDM is diagnosed by oral glucose tolerance test (OGTT), a rather cumbersome test for the women and health care system. The objectives of this study were to investigate whether HbA1c in first trimester of pregnancy could be used as a screening test for GDM in first trimester and throughout pregnancy in order to reduce the number of OGTTs, and whether it could predict preeclampsia and macrosomia in women with PCOS.
Post hoc analyses of data from 228 women from a prospective, randomised, multicenter study comparing metformin to placebo from first trimester to delivery. Fasting and 2-h plasma glucose were measured during a 75 g OGTT in first trimester, gestational week 19 and 32 as well as fasting plasma glucose in gestational week 36. GDM was diagnosed by WHO criteria from 1999 in first trimester and throughout pregnancy and by modified IADPSG criteria (i.e. lacking the 1-h plasma glucose value) in first trimester. The diagnostic accuracy was assessed by logistic regression and ROC curve analysis.
The area under the ROC curve for first trimester HbA1c for screening of GDM diagnosed by WHO criteria in first trimester was 0.60 (95 % CI 0.44-0.75) and 0.56 (95 % CI 0.47-0.65) for GDM diagnosed throughout pregnancy. Only 2.2 % (95 % CI 0.7-5.1 %) of the participants could have avoided OGTT. HbA1c was not statistically significantly associated with GDM diagnosed by modified IADPSG criteria in first trimester. However, first trimester HbA1c was statistically significantly associated with preeclampsia. Both HbA1c and GDM by WHO criteria in first trimester, but not by IADPSG, were negatively associated with birth weight.
First trimester HbA1c can not be used to exclude or predict GDM in women with PCOS, but it might be better to predict preeclampsia than the GDM diagnosis.
Additional file 1: Main characteristics of study participants by metformin use and GDM status. Numbers are median (min-max) or N (%).12902_2015_39_MOESM1_ESM.pdf
World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva: World Health Organization; 2013.
International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–34. CrossRef
O'Shea P, O'Connor C, Owens L, Carmody L, Avalos G, Nestor L, et al. Trimester-specific reference intervals for IFCC standardised haemoglobin A(1c): new criterion to diagnose gestational diabetes mellitus (GDM)? Ir Med J. 2012;105(5 Suppl):29–31. PubMed
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7. CrossRef
Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis. Am J Obstet Gynecol. 2011;204:558 e551–556. CrossRef
International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82. CrossRefPubMedCentral
World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva: World Health Organization; 1999.
Barrot A, Dupuy AM, Badiou S, Bargnoux AS, Cristol JP. Evaluation of three turbidimetric assays for automated determination of hemoglobin A1c. Clin Lab. 2012;58:1171–7. PubMed
Royston P, Sauerbrei W. Building multivariable regression models with continuous covariates in clinical epidemiology--with an emphasis on fractional polynomials. Methods Inf Med. 2005;44:561–71. PubMed
Helseth R, Salvesen O, Stafne SN, Morkved S, Salvesen KA, Carlsen SM: Gestational diabetes mellitus among Nordic Caucasian women: Prevalence and risk factors according to WHO and simplified IADPSG criteria. Scand J Clin Lab Invest. 2014;74:620-8.
Jenum AK, Morkrid K, Sletner L, Vangen S, Torper JL, Nakstad B, et al. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol. 2012;166:317–24. CrossRefPubMedPubMedCentral
Claesson R, Ekelund M, Berntorp K. The potential impact of new diagnostic criteria on the frequency of gestational diabetes mellitus in Sweden. Acta Obstet Gynecol Scand. 2013;92:1223–6. PubMed
Nallaperumal S, Bhavadharini B, Mahalakshmi MM, Maheswari K, Jalaja R, Moses A, et al. Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians. Indian J Endocrinol Metabol. 2013;17:906–9. CrossRef
- HbA1c as screening for gestational diabetes mellitus in women with polycystic ovary syndrome
Ingrid Hov Odsæter
Sven Magnus Carlsen
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II