An roole Muscle recovery Nutrition myth busters is related to gestatipnal occurrence Diabeetes microvascular disease, which may play a certain role in the HgAc of PIH bibtex BibTex. HbAc role in gestational diabetes was lower in the CGM group but not statistically significantly different. Prim Care Diabetes 15 5 —7. Overall, studies show no difference in maternal or fetal outcomes with CSII, but also no increase in harms, such as maternal hypoglycemia, DKA or weight gain. Of participants, Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study.

HbAc role in gestational diabetes -

FBG was determined using commercially available laboratory kits via enzymatic methods and spectrophotometry techniques. Between the 24th and 28th week of gestation, a Glucose Challenge Test GCT blood glucose one hour postg glucose without fasting was requested for all participants.

All tests were performed in the laboratory of Yas Hospital. The data were analyzed with the statistical software package IBM SPSS Statistic version The quantitative variables with normal distribution were compared between the groups using an independent T-test, and the Chi-square test was used to compare the categorical variables.

Receiver operating characteristic ROC curve was applied for sensitivity, specificity, positive PPV , and negative predictive value NPV calculation of distinct first-trimester HbA1c cut-off.

Of participants, Women with GDM had significantly older age, higher pre-gestational body mass index BMI , and pregnancy weight gain compared to the non-GDM pregnant women.

All the baseline characteristics of the pregnant women are summarized in Table 1. Flow chart of the study protocol. OGTT: Oral Glucose Tolerance Test. GDM: Gestational Diabetes Mellitus. In pregnant women with GDM, the average HbA1c level was 5.

In addition, HbA1c overlap in women with and without GDM. s is depicted in Fig. Use of HbA1c could decrease requesting OGTT in The area under the ROC curve for diagnosing GDM by HbA1c was 0. The diagnostic profile of HbA1c is shown in Table 2.

Receiver operating characteristic ROC curve for sensitivity and specificity according to different HbA1c and fasting blood glucose thresholds.

The area under the ROC curve for diagnosing GDM by FBG was 0. The diagnostic profile of FBG is shown in Table 3. The prevalence of GDM in our study was This variation is because of referring high-risk pregnant women to our hospital, using different GDM diagnostic thresholds, and different screening OGTTs in studies.

For instance, we used the Carpenter-Coustan threshold, which has a lower threshold for the GDM detection compared to the National diabetes data group that applied in Benaiges et al.

study [ 5 ]. In this study, we found that the average first-trimester FBG and HbA1c of GDM women were significantly higher compared with normoglycaemic women, which was similar to previous studies [ 5 , 17 ].

Although in our study, HbA1c in GDM women fell within the range of former studies, HbA1c in normoglycaemic women was lower the average HbA1c concentration reported in Asian Indian pregnant women, 5. This study has shown excellent reliability of HbA1c for the GDM diagnosis with an AUC of 0.

This finding was in line with some previous studies [ 20 , 21 , 22 ] such as a recent meta-analysis evaluating pregnant women [ 23 ] in which the AUC values ranged from 0. GDM has public health implications and the early detection of it is clinically essential. Women with GDM are at risk for developing type 2 diabetes mellitus and impaired glucose tolerance and have a higher risk for cardiovascular diseases along with their life [ 16 ].

The appropriate test for GDM diagnosis is a test with a high sensitivity to diagnose the patients and high specificity, but this could not be observed in the HbA1c test.

As found in our study, by increasing HbA1c, the sensitivity decreased, and the specificity increased. Although using the higher 5. Despite the acceptance of HbA1c among pregnant women and its advantages over other GDM diagnostic methods, such as its less intra-individual coefficient of variation of 1.

Another challenge with HbA1c is its significantly decreasing in pregnancy, a decline of the upper normal level of HbA1c from 6. Furthermore, physiological hydremia during pregnancy, anemia, slower intestinal transition, increased red cell turnover, and nutritional alternations are factors that can considerably affect the HbA1c value [ 32 ].

For these reasons, there is no guideline using HbA1c for the diagnosis of GDM. The advantage of our research was the large sample. Furthermore, all information was gathered from the same lab and the same clinic. However, our study had some limitations. For instance, we did not evaluate the cost-saving potentials while using HbA1c for screening GDM.

In addition, there are possible variations in the degree of HbA1c, independent of glycemia, which could be associated with family history or genetics. In this study, we did not include these factors. It seems that the first-trimester HbA1c, because of its insufficient sensitivity or specificity, cannot replace OGTT for the diagnosis of GDM.

However, women with higher first-trimester HbA1c have a high risk for GDM. Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics FIGO initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care.

Int J Gynaecol Obstet. Article Google Scholar. Yuen L, Saeedi P, Riaz M, Karuranga S, Divakar H, Levitt N, et al. Projections of the prevalence of hyperglycaemia in pregnancy in and beyond: Results from the International Diabetes Federation Diabetes Atlas, 9th edition.

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Diabetes Care. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. Benaiges D, Flores-Le Roux JA, Marcelo I, et al. Is first-trimester HbA1c useful in the diagnosis of gestational diabetes? Article CAS Google Scholar.

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Minerva Endocrinol. CAS PubMed Google Scholar. Popova P, Tkachuk A, Dronova A, Gerasimov A, Kravchuk E, Bolshakova M, et al. Fasting glycemia at the first prenatal visit and pregnancy outcomes in Russian women. PubMed Google Scholar. Zhu WW, Fan L, Yang HX, et al.

Fasting plasma glucose at weeks to screen for gestational diabetes mellitus: new evidence from China. Hughes RC, Rowan J, Florkowski CM. Is there a role for HbA1c in pregnancy? Curr Diab Rep. Agarwal MM, Punnose J, Dhatt GS. Gestational diabetes: problems associated with the oral glucose tolerance test.

Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term variability in measures of glycemia and implications for the classification of diabetes. Arch Intern Med. Ye M, Liu Y, Cao X, et al. The utility of HbA1c for screening gestational diabetes mellitus and its relationship with adverse pregnancy outcomes.

American Diabetes Association. Hughes RCE, Moore MP, Gullam JE, Mohamed K, Rowan J. Mañé L, Flores-Le Roux JA, Benaiges D, Rodríguez M, Marcelo I, Chillarón JJ, et al. conceived and designed the study, collected data, performed data analysis, reviewed the manuscript, and contributed to discussion.

collected data and drafted the manuscript. collected data, performed data analysis, and reviewed the manuscript. collected data, reviewed the manuscript, and contributed to discussion.

contributed to data analysis and reviewed the manuscript. collected data and reviewed the manuscript. reviewed the manuscript. conceived and designed the study, collected data, reviewed the manuscript, and contributed to discussion. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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BMC Pregnancy Childbirth. Ahmad J , Rafat D. HbA1c and iron deficiency: a review. The results indicated that there were no differences in the maternal characteristics, glucose levels, or pregnancy outcomes between the HbA1c and non-HbA1c groups, except for the results for the g, 1-h OGTT and the prolonged labor outcome S1 Table.

We also identified similar overall rates of GDM diagnosis in the patients who did versus did not undergo HbA1c monitoring Thus, there appeared to be no selection bias in the HbA1c group. An ROC curve Fig 3 was generated to determine the sensitivity and specificity of the mid-pregnancy HbA1c level in the detection of GDM.

The area under the ROC curve for HbA1c in the detection of GDM was 0. The optimal cut-off value, which maximized the sum of the sensitivity and specificity, was 5. ROC, receiver operating characteristic; HbA1c, hemoglobin A1c; GDM, gestational diabetes mellitus. Table 1 presents the rates of adverse pregnancy outcomes according to the mid-pregnancy HbA1c level.

Only one woman had intrauterine fetal death, and her HbA1c level was 5. Table 2 presents the trends and OR ranges. The multiple logistic regression analysis indicated that compared with the HbA1c category of 4.

The ORs for caesarean section, gestational hypertension or preeclampsia, preterm delivery, NICU admission, and low birth weight exhibited a J-shaped distribution. In the additional analysis adjusted for both HbA1c and GDM , collinearity between the HbA1c level and GDM was identified; however, we elected to maintain both variables in the regression model to control for the possibility of bias, and the results were similar.

The associations between maternal characteristics and the HbA1c level are shown in S2 Table. In this study, we determined that the optimal cut-off point of the HbA1c level with maximal sensitivity and specificity to predict GDM was 5.

The area under the ROC curve of the HbA1c level for the detection of GDM was 0. These findings confirmed the lack of adequate sensitivity and specificity in many previous studies [ 11 , 19 — 22 ]. GDM was diagnosed by the International Association of Diabetes and Pregnancy Study Groups IADPSG criteria using a one-step g, 2-h OGTT.

The results indicated a first-trimester HbA1c level of 5. In another study, the OGTT and HbA1c tests were performed in pregnant women at 24—28 weeks of gestation. The cut-off point of the HbA1c level was 5. In Korean women, the HbA1c level at a cut-off point of 5.

We further attempted to salvage a positive outlook on the use of mid-pregnancy HbA1c levels. A further objective was to determine whether a combination of maternal age, the g, 1-h GCT and the mid-pregnancy HbA1c level would reduce the need for a subsequent g, 3-h OGTT.

Thus, we concluded that the mid-pregnancy HbA1c level could not replace a two-step diagnostic approach to identify GDM. However, a recent study reported that mid-pregnancy HbA1c may potentially reduce the number of OGTTs.

It appears different criteria the Carpenter-Coustan criteria using a two-step diagnostic approach vs. the IADPSG criteria using a one-step g, 2-h OGTT for GDM diagnosis affect the results. Further comparison studies are required. Our findings demonstrated that the mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in a continuous fashion.

These outcomes included gestational hypertension or preeclampsia, preterm delivery, NICU admission, low birth weight, and macrosomia. The results provided supporting evidence for recent reports that the HbA1c level during pregnancy was associated with adverse pregnancy outcomes [ 14 — 16 ].

Thus, the mid-pregnancy HbA1c level may be used as a prognostic biomarker for adverse pregnancy outcomes. In addition, compared with the women with HbA1c levels of 4.

Similar J-shaped relationships have been identified for HbA1c levels and cardiovascular, cancer and all-cause mortality in patients with diabetes in the Ludwigshafen Risk and Cardiovascular Health study [ 23 ].

For adults without overt diabetes, a J-shaped relationship was also identified between the HbA1c levels and all-cause mortality in the Atherosclerosis Risk in Communities ARIC study and in a New Zealand linkage study [ 24 , 25 ]. However, there have been limited studies regarding this relationship in pregnant women.

We hypothesized that low HbA1c levels measured at GDM diagnosis may potentially reflect a chronic, consuming physiopathological condition, which may lead to adverse pregnancy outcomes.

Additional studies are required to confirm these results and determine the potential mechanisms that may underlie this association [ 26 , 27 ].

The strength of the study was the assessment of the clinical usefulness of a mid-pregnancy HbA1c measurement as a replacement for the OGTT in pregnancy using a relatively large population over a 7-year period. In Taiwan, the NHI provided 10 prenatal examinations by obstetrician gynecologists for pregnant women.

Our study was based on the prenatal visit service of the NHI, which may refine the HbA1c measurement in this study and the diagnosis of GDM.

Nevertheless, because of the single-center non-randomized design, we should be cautious regarding the generalizability. Additional, large-scale, multi-center, randomized control design studies are required. However, it lacked adequate sensitivity and specificity to replace a two-step diagnostic approach for GDM.

The current study was a single-center prospective study; thus, additional, randomized control design studies are required. GCT, glucose challenge test; HbA1c, hemoglobin A1c; GDM, gestational diabetes mellitus; OGTT, oral glucose tolerance test.

HbA1c, hemoglobin A1c; BMI, body mass index; GCT, glucose challenge test; OGTT, oral glucose tolerance test; GDM, gestational diabetes mellitus; NICU, neonatal intensive care unit. Continuous variables are presented as the median 25thth and were analyzed using the Wilcoxon rank sum test.

b Caesarean as a result of prolonged labor, macrosomia, or cephalopelvic disproportion, with the exclusion of elective caesarean sections and caesarean sections scheduled because of a previous cesarean section, placenta previa, and malposition or malpresentation of fetus.

c Only includes vaginal deliveries. HbA1c, hemoglobin A1c; BMI, body mass index. Continuous variables are presented as the mean ± SD or median 25thth and were analyzed using analysis of variance ANOVA or the Kruskal-Wallis test, as appropriate.

Conceptualization: YRH PW MCL CPY YHY. Data curation: PW MCL. Formal analysis: MCL. Investigation: YRH PW MCL YHY. Methodology: YRH PW MCL YHY. Project administration: CPY YHY. Resources: PW YHY.

Software: MCL YHY. Supervision: PW CPY YHY. Validation: YRH STT YHY. Visualization: MCL YHY. Writing — original draft: YRH MCL YHY. Browse Subject Areas?

Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Methods This prospective study enrolled 1, pregnant Taiwanese women. Results 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.

Conclusions The mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in high-risk Taiwanese women. Funding: The authors received no specific funding for this work. Introduction For the previous 30 years, investigators have attempted to determine whether the glycated hemoglobin A1c HbA1c level during pregnancy may be used as a screening or diagnostic test for gestational diabetes GDM [ 1 — 3 ].

Research design and methods Study participants This prospective study enrolled all pregnant women without overt diabetes and with positive g, 1-h GCT results who subsequently underwent a g, 3-h OGTT at the outpatient clinics of the Ditmanson Medical Foundation Chia-Yi Christian Hospital DMF-CYCH between March and September Download: PPT.

Two-step diagnostic approach for GDM As a result of the health policy and National Health Insurance NHI coverage, most non-diabetic pregnant women in Taiwan were administered a g, 1-h GCT at 24—28 weeks of gestation.

Fig 2. Gestational week of GDM screening using a two-step diagnostic approach and time frame for receiving the HbA1c test. HbA1c measurement and classification HbA1c was measured at the time the g, 3-h OGTT was performed.

Statistical analysis Continuous variables are descriptively expressed as the mean ± standard deviation SD and were analyzed using analysis of variance ANOVA ; alternatively, they are expressed as the median 25thth and were analyzed using non-parametric tests the Kruskal-Wallis test or the Wilcoxon rank-sum test when the data were not normally distributed.

Results The study enrolled 3, pregnant women without overt diabetes and with positive g, 1-h GCT results who subsequently underwent the g, 3-h OGTT and delivered at DMF-CYCH during the study period. Fig 3.

Address all correspondence and gfstational for Phytochemical supplementation gesrational Juana HbAc role in gestational diabetes Flores-Le Diaetes, MD, PhD, Department of Endocrinology and Nutrition, Hospital HbAc role in gestational diabetes Mar, Paseo Overload principle in training adaptationsE Barcelona, Spain. E-mail: gfstational. Risk of obstetric complications increases linearly with rising maternal glycemia. Testing hemoglobin A1c HbA1c is an effective option to detect hyperglycemia, but its association with adverse pregnancy outcomes remains unclear. A prospective study was conducted at Hospital del Mar, Barcelona, between April and September Primary outcome was macrosomia. Secondary outcomes were preeclampsia, preterm birth, and cesarean section rate. Objective: To evaluate Phytochemical supplementation haemoglobin as Phytochemical supplementation biomarker for diagnosing gestational diabetes gestatoinal while keeping Muscle recovery oral glucose tolerance test as the gold gesattional. Methods: The cross-sectional Diet and lifestyle choices for cancer prevention was conducted gesttaional Januray,to Gestatonal,at PNS Hafeez Hospital, Islamabad, Pakistan and comprised of pregnant subjects who were first subjected to 2-hour oral glucose tolerance test along with the first evaluation of glycated haemoglobin. Clinical evaluation, including history and measurements of anthropometric indices and blood pressure, were also done. On the basis of the results, the subjects were grouped as those having gestational diabetes mellitus group A and those without it group B. Data was analysed using SPSS