Early pregnancy HbA1c test allows effective screening for high risk mothers: Study

A new study found that early pregnancy HbA1c to be an effective screening test for high risk mothers and allows early intervention and reduce the need for oral glucose tolerance test (OGTT). The findings were published in the recent issue of The Lancet Diabetes & Endocrinology journal.

The STRiDE (Screening for Gestational Diabetes in Low- and Middle-Income Countries) study was conducted across seven centers in South India and seven centers in Western Kenya. Pregnant women aged 18 to 50 years and less than 16 weeks of gestation (less than 20 weeks in Kenya) were included after confirming their pregnancies by dating ultrasound. The study evaluated the effectiveness of early pregnancy HbA1c levels, both venous and capillary point-of-care, either alone or as part of a composite risk score including age, BMI and family history of diabetes to predict gestational diabetes at 24-28 weeks of gestation.

The STRiDE study from February 15, 2016 to December 13, 2019 enrolled a total of 3,070 participants in India and 4,104 in Kenya. Also, 4,320 participants from the PRiDE cohort in the UK were included for comparison. As diagnosed by OGTT at 24-28 weeks, the prevalence of gestational diabetes was found to be 19.2% in India, 3.0% in Kenya and 14.5% in the UK.

Early pregnancy HbA1c levels showed a significant independent association with the incidence of gestational diabetes at 24-28 weeks. The adjusted risk ratios were 1.60 in India, 3.49 in Kenya, and 4.72 in the UK.

Composite risk score models combined HbA1c with age, BMI and family history of diabetes and proved to be effective in predicting gestational diabetes. This innovative screening strategy used a population-specific two-threshold model to rule in or rule out gestational diabetes based on early pregnancy composite risk scores. This has the potential to reduce the need for OGTTs by 50-64%.

In the HbA1c-alone model, the thresholds for ruling in and ruling out gestational diabetes were determined as 5.4% and 4.9% in India, 6.0% and 5.2% in Kenya and 5.6% and 5.2% in the UK. Overall, the findings suggest that early pregnancy HbA1c is found to be an effective screening test for gestational diabetes by allowing women at highest risk to receive early intervention and significantly reducing the need for OGTTs.

Source:

Saravanan, P., Deepa, M., Ahmed, Z., Ram, U., Surapaneni, T., Kallur, S. D., Desari, P., Suresh, S., Anjana, R. M., Hannah, W., Shivashri, C., Hemavathy, S., Sukumar, N., Kosgei, W. K., Christoffersen-Deb, A., Kibet, V., Hector, J. N., Anusu, G., Stallard, N., … Mohan, V. (2024). Early pregnancy HbA1c as the first screening test for gestational diabetes: results from three prospective cohorts. In The Lancet Diabetes & Endocrinology. Elsevier BV. https://doi.org/10.1016/s2213-8587(24)00151-7