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Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus

Citation

Khalafallah, A and Phuah, E and Al-Barazan, AM and Nikakis, I and Radford, A and Clarkson, W and Trevett, C and Brain, T and Gebski, V and Corbould, A, Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus, BMJ Open, 6, (4) Article e011059. ISSN 2044-6055 (2016) [Refereed Article]


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Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/

DOI: doi:10.1136/bmjopen-2016-011059

Abstract

OBJECTIVES: The oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the most accepted measure of chronic glycaemia outside of pregnancy. HbA1c is an uncomplicated test, less time consuming, does not require any specific patient preparation and is considered straightforward compared with the OGTT. Therefore, we prospectively tested the utility of the HbA1c when used as a screening tool in pregnancy for gestational diabetes mellitus (GDM).

SETTINGS: Primary health care. Single tertiary referral centre, Tasmania, Australia.

PARTICIPANTS: A direct comparison between HbA1c levels and the OGTT results in pregnant women, tested concurrently at the 24-28 gestational week, was undertaken. A full profile of 480 pregnant women during the period from September 2012 to July 2014 was completed. Median and mean age of participants was 29 years (range 18-47 years).

INTERVENTIONS: A simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed.

RESULTS: The number of women who had GDM according to OGTT criteria was 57, representing 11.9% of the evaluated 480 pregnant women. Using a cut-off value for HbA1c at 5.1% (32 mmol/mol) for detecting GDM showed sensitivity of 61% and specificity of 68% with negative predictive value (NPV) of 93%, versus sensitivity of 27% and specificity of 95% with NPV of 91% when using HbA1c cut-off value of 5.4% (36 mmol/mol).

CONCLUSIONS: Our results suggest that pregnant women with an HbA1c of≥5.4% (36 mmol/mol) should proceed with an OGTT. This may result in a significant reduction in the burden of testing on both patients and testing facility staff and resources. Further investigations are required to integrate and optimise the HbA1c as a single, non-fasting, screening tool for GDM.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Endocrinology
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Diabetes
Author:Khalafallah, A (Professor Alhossain Khalafallah)
Author:Al-Barazan, AM (Dr Abdul Majeed)
Author:Corbould, A (Dr Anne Corbould)
ID Code:109419
Year Published:2016
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-06-15
Last Modified:2017-02-15
Downloads:66 View Download Statistics

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