HbA1c as screening for gestational diabetes mellitus in women with polycystic ovary syndrome

BMC Endocrine Disorders

Sven Magnus Carlsen⁴  Eszter Vanky²  Arne Åsberg¹  Ingrid Hov Odsæter³ 

[1] Department of Clinical Chemistry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Department of Laboratory Medicine, Children’s and Women’s Health, Trondheim, Norway;Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

关键词: Birth weight;    Preeclampsia;    HbA1c;    Polycystic ovary syndrome;    Gestational diabetes mellitus;   

Others  :  1222362
DOI  :  10.1186/s12902-015-0039-9

 received in 2015-03-08, accepted in 2015-07-29,  发布年份 2015

【 摘 要 】

Background

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.

Methods

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.

Results

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.

Conclusion

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.

【 授权许可】

   
2015 Odsæter et al.

【 图 表 】

Fig. 1.

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