Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women

• Published in: PloS one Vol. 12; no. 5; p. e0177563
• Main Authors: Ho, Yi-Ran, Wang, Panchalli, Lu, Mei-Chun, Tseng, Shih-Ting, Yang, Chun-Pai, Yan, Yuan-Horng
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.05.2017; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Age; Angiography; Asian Continental Ancestry Group; Biology and life sciences; Biomarkers; Blood glucose; Body mass; Body mass index; Cancer; Cardiovascular diseases; Control; Criteria; Cut-off; Diabetes; Diabetes mellitus; Diabetes, Gestational - blood; Diabetes, Gestational - diagnosis; Diabetes, Gestational - epidemiology; Diagnosis; Diagnostic software; Diagnostic systems; Downloading; Electronic mail; Endocrinology; Female; Fetuses; Food; Format; Gestation; Gestational diabetes; Glucose; Glucose tolerance; Glycated Hemoglobin A; Gynecology; Health aspects; Health risk assessment; Health risks; Hemoglobin; Humans; Hygiene; Hyperglycemia; Infant, Newborn; Maternal & child health; Measurement; Medical diagnosis; Medical records; Medicine and health sciences; Metabolism; Mortality; Neurology; Nutrition; Obstetrics; Odds Ratio; Pregnancy; Pregnancy Outcome; Public health; Public Health Surveillance; Regression models; Risk; Risk factors; ROC Curve; Taiwan - epidemiology; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0177563

The objective of this study was to investigate the associations among the mid-pregnancy glycated hemoglobin A1c (HbA1c) level, gestational diabetes (GDM), and risk of adverse pregnancy outcomes in women without overt diabetes and with positive 50-g, 1-h glucose challenge test (GCT) results (140 mg/dL or greater). This prospective study enrolled 1,989 pregnant Taiwanese women. A two-step approach, including a 50-g, 1-h GCT and 100-g, 3-h oral glucose tolerance test (OGTT), was employed for the diagnosis of GDM at weeks 23-32. The mid-pregnancy HbA1c level was measured at the time the OGTT was performed. A receiver operating characteristic (ROC) curve was used to determine the relationship between the mid-pregnancy HbA1c level and GDM. Multiple logistic regression models were implemented to assess the relationships between the mid-pregnancy HbA1c level and adverse pregnancy outcomes. An ROC curve demonstrated that the optimal mid-pregnancy HbA1c cut-off point to predict GDM, as diagnosed by the Carpenter-Coustan criteria using a two-step approach, was 5.7%. The area under the ROC curve of the mid-pregnancy HbA1c level for GDM was 0.70. Compared with the levels of 4.5-4.9%, higher mid-pregnancy HbA1c levels (5.0-5.4, 5.5-5.9, 6.0-6.4, 6.5-6.9, and >7.0%) were significantly associated with increased risks of gestational hypertension or preeclampsia, preterm delivery, admission to the neonatal intensive care unit, low birth weight, and macrosomia (the odds ratio [OR] ranges were 1.20-9.98, 1.31-5.16, 0.88-3.15, 0.89-4.10, and 2.22-27.86, respectively). The mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in high-risk Taiwanese women. However, it lacked adequate sensitivity and specificity to replace the two-step approach in the diagnosis of GDM. The current study comprised a single-center prospective study; thus, additional, randomized control design studies are required.