Glycated haemoglobin in the first trimester: A predictor of gestational diabetes mellitus in pregnant Asian Indian women

Aim: To assess the efficacy of first trimester glycated hemoglobin (HbA1c-FT) in diagnosing or predicting gestational diabetes mellitus (GDM) in Asian Indian women. Methods: This retrospective cohort study involved 2275 women who underwent both HbA1c-FT estimation and GDM screening with a one-step 75 g oral glucose tolerance test. Receiver Operating Characteristic (ROC) curve statistics were applied to assess the discriminative ability of HbA1c-FT in GDM diagnosis. A multivariable logistic regression analysis after adjusting for plausible confounders was used to evaluate the independent effect of HbA1c-FT on GDM diagnosis. Results: The mean HbA1c-FT of GDM (n = 578) and non-GDM women (n = 1697) were 5.04 + 0.04% and 4.9 + 0.37%, respectively (p < 0.001). Compared to women with a HbA1c-FT < 5.2%, the adjusted odds ratio to develop GDM of women with an HbA1c-FT range of 5.2-5.5% and those >5.6% to develop GDM were 1.627 (p < 0.004) and 2.6 (p < 0.001), respectively. The area under the ROC curve to detect GDM was 0.606 (95% CI: 0.519-0.633 p < 0.001), but the sensitivity and specificity of the HbA1c-FTwere not sufficient to diagnose, rule in or rule out GDM. Conclusions: HbA1c-FT is an independent GDM predictor in Asian Indian women but lacks sufficient sensitivity or specificity for use as a diagnostic test. (C) 2019 Elsevier B.V. All rights reserved.