Increased HbA1c and HOMA-IR may predict risk of gestational diabetes early in pregnancy

They also mentioned that gestational diabetes risk is higher when both HbA1c and HOMA-IR are higher. The study has addressed the need to identify high-risk women for gestational diabetes mellitus early in pregnancy so that timely interventions could be provided.

Researchers in the present study investigated the association of glycated haemoglobin (HbA1c) and homeostasis model assessment insulin resistance (HOMA-IR) with gestational diabetes mellitus (GDM) risk. They included pregnant women with HbA1c, fasting insulin, and fasting glucose (FG) measured at 15-20 weeks of gestation. These underwent oral glucose tolerance test (OGTT) at 24-28 weeks.

The study results explained as follows:

• Researchers identified 462 women, out of which 29.44 % of women developed GDM.
• Based on HbA1c and HOMA-IR, there were four groups in the study population, with the percentages of each group being 51.30%, 15.58%, 20.56%, and 12.55%, respectively.
• With the increase in HOMA-IR and HbA1c, GDM incidence increased with the increase of HOMA-IR and HbA1c, respectively.
• GDM risk increased when both HOMA-IR and HbA1c were elevated.
• In pregnant women < 35 years, there was no risk.
• Finally, we found significantly higher FG at 24-28 weeks in the high HOMA-IR and HbA1c group among GDM-positive pregnant women.

The study has highlighted that GDM incidence increases with increasing HOMA-IR and HbA1c, respectively carrying the highest risk when maternal HOMA- IR and HbA1c are elevated in pregnant women aged ≥ 35 years.

They said, based on the results of our study, we found that among pregnant women with GDM, fasting glucose is higher at 24-28 weeks in those with elevated IR and HbA1c, independent of age.

Further reading:

Combining HbA1c and insulin resistance to assess the risk of gestational diabetes mellitus: a prospective cohort study. https://doi.org/10.1016/j.diabres.2023.110673