Clinical Trials Study
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World J Obstet Gynecol. Aug 10, 2014; 3(3): 130-133
Published online Aug 10, 2014. doi: 10.5317/wjog.v3.i3.130
Utility of a hemoglobin A1C obtained at the first prenatal visit
Lisa E Moore, Diana Clokey
Lisa E Moore, Diana Clokey, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of New Mexico, Albuquerque, NM 87131, United States
Author contributions: Moore LE designed the study, analyzed data, and wrote the paper; Clokey D recruited patients to the study, provided diabetic education to patients in the study and collected data.
Correspondence to: Lisa E Moore, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of New Mexico, MSC105580, Albuquerque, NM 87131, United States. lemoore@salud.unm.edu
Telephone: +1-505-2726381 Fax: +1-505-2726386
Received: March 11, 2014
Revised: May 20, 2014
Accepted: June 10, 2014
Published online: August 10, 2014
Processing time: 193 Days and 13.7 Hours
Abstract

AIM: To evaluate the utility of the hemoglobin A1C (HbA1C) at the first prenatal visit as a triaging tool in patients at high risk for gestational diabetes (GDM).

METHODS: The HbA1C was obtained at the first prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% (group one) were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% (group two) were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C < 5.7% (group three) were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL (5.3 mmol/L) and 2 h postprandial ≤ 120 mg/dL (6.7 mmol/L).

RESULTS: In group one (n = 16), 15/16 (95%) required medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients (87%) remained diabetic. Group two contained 82 patients. Sixty-sixpatients (80%) were given a diagnosis of GDM and 52 patients (64%) required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients (8.7%) were diagnosed with GDM and 13 patients (6%) required medication. In comparison to group three, patients in group one were 220 times more likely to require medication (95%CI: 26.9- > 999, P < 0.0001). Patients in group two were 26 times more likely to require medication (95%CI: 12.5-54.3, P < 0.0001).

CONCLUSION: A HbA1C obtained at the first prenatal visit can be used to triage patients based on the level of glucose intolerance found.

Keywords: Gestational diabetes; Pregnancy; Hemoglobin A1C; Glycosylated hemoglobin

Core tip: Hemoglobin A1C (HbA1C) has been endorsed by the World Health Organization for use in diagnosing diabetes and also for identifying degrees of glucose intolerance. This has not been validated in pregnancy. This study looks at a cohort of patients who received a HbA1C at the begining of pregnancy to see if the HbA1C can be used as a triaging tool for identifying patients with undiagnosed diabetes and for identifying a degree of glucose intolerance that would benefit from early intervention. HbA1C ≥ 6.5% is consistent with preexisting diabetes. HbA1C between 5.7% and 6.4% demonstrates a level of glucose intolerance associated with risk of Gestational Diabetes which may benefit from early intervention.