Abstract
Aims: To investigate the performance of early pregnancy HbA1c for predicting gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in obese women. Methods: Post hoc analysis using data from the Vitamin D And Lifestyle Intervention for GDM prevention trials conducted across 9 European countries (2012–2014). Pregnant women (BMI ≥ 29 kg/m2) underwent a baseline HbA1c and oral glucose tolerance tests at < 20 weeks, 24–28 weeks, and 35–37 weeks. Women with GDM were referred for treatment. Results: Among the 869 women tested, the prevalence of GDM was 25.9% before 20 weeks, with a further 8.6% at 24–28 weeks. The areas under the curves for HbA1c at the two time points were 0.55 (0.50–0.59) and 0.54 (0.47–0.61), respectively. An early HbA1c ≥ 5.7% (39 mmol/mol) (N = 111) showed low sensitivity (18.2%) with 89.1% specificity for GDM before 20 weeks, at 24–28 weeks (sensitivity of 8.0% and specificity of 88.6% after excluding early GDM), and throughout gestation (sensitivity of 15.9% and specificity of 89.4%). The ≥ 5.7% (39 mmol/mol) threshold was significantly associated with concurrent GDM before 20 weeks (adjusted OR (aOR) 2.77(1.39–5.51)) and throughout gestation (aOR 1.72 (1.02–2.89)), but not adverse pregnancy outcomes. Conclusions: Early pregnancy HbA1c is of limited use for predicting either GDM or adverse outcomes in overweight/obese European women.
Original language | English |
---|---|
Article number | 108378 |
Journal | Diabetes Research and Clinical Practice |
Volume | 168 |
DOIs | |
Publication status | Published - 1 Oct 2020 |
Keywords
- Diagnostic threshold
- Gestational diabetes mellitus
- Hemoglobin A
- Odds Ratio
- Pregnancy
- Pregnancy outcome
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In: Diabetes Research and Clinical Practice, Vol. 168, 108378, 01.10.2020.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Performance of early pregnancy HbA1c for predicting gestational diabetes mellitus and adverse pregnancy outcomes in obese European women
AU - Immanuel, Jincy
AU - Simmons, David
AU - Desoye, Gernot
AU - Corcoy, Rosa
AU - Adelantado, Juan M.
AU - Devlieger, Roland
AU - Lapolla, Annunziata
AU - Dalfra, Maria G.
AU - Bertolotto, Alessandra
AU - Harreiter, Jürgen
AU - Wender-Ozegowska, Ewa
AU - Zawiejska, Agnieszka
AU - Dunne, Fidelma P.
AU - Damm, Peter
AU - Mathiesen, Elisabeth R.
AU - Jensen, Dorte M.
AU - Andersen, Lise Lotte T.
AU - Hill, David J.
AU - Jelsma, Judith G.M.
AU - Snoek, Frank J.
AU - Scharnagl, Hubert
AU - Galjaard, Sander
AU - Kautzky-Willer, Alexandra
AU - VAN Poppel, Mireille N.M.
N1 - Funding Information: Professor Andre van Assche, PhD from the KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Belgium and Gynaecology and Obstetrics, University Hospitals Leuven, Belgium contributed equally to the study but sadly passed away before submission. JI undertook the statistical analyses, interpreted the data and drafted the manuscript. DS conceived the project, supervised JI, interpreted the data, reviewed and edited the draft and provided critical input to the manuscript. DS, RC, RD, AVA, AL, EW, AK, FD, PD, ERM, DH and FS designed and executed the DALI study and provided input for the interpretation of the results. DS was the study coordinator. JMA, SG, MGD, AB, JH, AZ, DMJ, LTA, HS, JJ contributed to the execution of the study and provided input for the interpretation of the results. GD designed and executed the study and provided input for the interpretation of the results. He was the principal investigator of the study. MVP designed and executed the study and provided input for the interpretation of the results. She was the sponsor of the study. All authors read and approved the final manuscript. J.I. is the guarantor of this work and takes full responsibility for the contents of this article. This project received funding from the European Community's 7th Framework Program (FP7/2007-2013; grant agreement no. 242187). In the Netherlands, additional funding was provided by the Netherlands Organization for Health Research and Development (ZonMW) (Grant nr 200310013). In the UK, the DALI team acknowledges the support received from the NIHR Clinical Research Network: Eastern, especially the local diabetes clinical and research teams based in Cambridge. In Spain, additional funding was provided by CAIBER 1527-B-226. JI is supported by a postgraduate research scholarship from Western Sydney University Australia. Clinical trial registration number: ISRCTN70595832. Paper presentation information: Parts of this study were presented at the Diabetes UK Professional Conference, Liverpool, UK, 6?8 March, 2019 and the Australian Diabetes in Pregnancy Society Annual Scientific Meeting, Sydney, Australia, 23?29 August, 2019. D Simmons, J Immanuel, F Dunne, et al. An early pregnancy HbA1c ? 41 mmol/mol (5.9%) is not a good biomarker for early or late Gestational Diabetes (GDM) and does not predict GDM associated complications in obese women. Diabetic medicine. Special issue: Abstracts of the Diabetes UK Professional Conference 2019, ACC Liverpool, 6-8 March 2019. A10 (P92). https://doi.org/10.1111/dme.1_13882 Funding Information: This project received funding from the European Community’s 7th Framework Program (FP7/2007-2013; grant agreement no. 242187). In the Netherlands, additional funding was provided by the Netherlands Organization for Health Research and Development (ZonMW) (Grant nr 200310013 ). In the UK, the DALI team acknowledges the support received from the NIHR Clinical Research Network: Eastern, especially the local diabetes clinical and research teams based in Cambridge. In Spain, additional funding was provided by CAIBER 1527-B-226. JI is supported by a postgraduate research scholarship from Western Sydney University Australia.. Publisher Copyright: © 2020 Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Aims: To investigate the performance of early pregnancy HbA1c for predicting gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in obese women. Methods: Post hoc analysis using data from the Vitamin D And Lifestyle Intervention for GDM prevention trials conducted across 9 European countries (2012–2014). Pregnant women (BMI ≥ 29 kg/m2) underwent a baseline HbA1c and oral glucose tolerance tests at < 20 weeks, 24–28 weeks, and 35–37 weeks. Women with GDM were referred for treatment. Results: Among the 869 women tested, the prevalence of GDM was 25.9% before 20 weeks, with a further 8.6% at 24–28 weeks. The areas under the curves for HbA1c at the two time points were 0.55 (0.50–0.59) and 0.54 (0.47–0.61), respectively. An early HbA1c ≥ 5.7% (39 mmol/mol) (N = 111) showed low sensitivity (18.2%) with 89.1% specificity for GDM before 20 weeks, at 24–28 weeks (sensitivity of 8.0% and specificity of 88.6% after excluding early GDM), and throughout gestation (sensitivity of 15.9% and specificity of 89.4%). The ≥ 5.7% (39 mmol/mol) threshold was significantly associated with concurrent GDM before 20 weeks (adjusted OR (aOR) 2.77(1.39–5.51)) and throughout gestation (aOR 1.72 (1.02–2.89)), but not adverse pregnancy outcomes. Conclusions: Early pregnancy HbA1c is of limited use for predicting either GDM or adverse outcomes in overweight/obese European women.
AB - Aims: To investigate the performance of early pregnancy HbA1c for predicting gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in obese women. Methods: Post hoc analysis using data from the Vitamin D And Lifestyle Intervention for GDM prevention trials conducted across 9 European countries (2012–2014). Pregnant women (BMI ≥ 29 kg/m2) underwent a baseline HbA1c and oral glucose tolerance tests at < 20 weeks, 24–28 weeks, and 35–37 weeks. Women with GDM were referred for treatment. Results: Among the 869 women tested, the prevalence of GDM was 25.9% before 20 weeks, with a further 8.6% at 24–28 weeks. The areas under the curves for HbA1c at the two time points were 0.55 (0.50–0.59) and 0.54 (0.47–0.61), respectively. An early HbA1c ≥ 5.7% (39 mmol/mol) (N = 111) showed low sensitivity (18.2%) with 89.1% specificity for GDM before 20 weeks, at 24–28 weeks (sensitivity of 8.0% and specificity of 88.6% after excluding early GDM), and throughout gestation (sensitivity of 15.9% and specificity of 89.4%). The ≥ 5.7% (39 mmol/mol) threshold was significantly associated with concurrent GDM before 20 weeks (adjusted OR (aOR) 2.77(1.39–5.51)) and throughout gestation (aOR 1.72 (1.02–2.89)), but not adverse pregnancy outcomes. Conclusions: Early pregnancy HbA1c is of limited use for predicting either GDM or adverse outcomes in overweight/obese European women.
KW - Diagnostic threshold
KW - Gestational diabetes mellitus
KW - Hemoglobin A
KW - Odds Ratio
KW - Pregnancy
KW - Pregnancy outcome
UR - http://www.scopus.com/inward/record.url?scp=85090030724&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.diabres.2020.108378
DO - https://doi.org/10.1016/j.diabres.2020.108378
M3 - Article
C2 - 32828833
SN - 0168-8227
VL - 168
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 108378
ER -