First-Trimester HbA1c Outperforms Asprosin for GDM Prediction: Clinical Insights From a Cohort

Can We Screen for GDM Risk Before It Begins?

What if you could identify which of your newly pregnant patients are most likely to develop gestational diabetes—months before classic screening? That’s the question driving research into early biomarkers like HbA1c and asprosin. A new study from northern Thailand offers key evidence on their practical value for clinicians.

Study Overview: Prospective Data From 250 Pregnancies

Researchers enrolled 250 singleton pregnancies and measured both first-trimester HbA1c (a blood test reflecting average blood sugar over the past few months) and asprosin (a newer hormone thought to play a role in energy balance and glucose regulation). All women had standard gestational diabetes screening in the second trimester and were followed until delivery. The goal: see if early lab values predicted later GDM, insulin requirement, or common maternal or neonatal complications.

Key Findings: First-Trimester HbA1c—Not Asprosin—Tells the Early Story

HbA1c in the first trimester proved to be a strong independent predictor of subsequent GDM (adjusted OR: 6.53) and the likelihood of requiring insulin for glycemic control later in pregnancy (adjusted OR: 28.3).

Asprosin measured early in pregnancy was not associated with the later development of GDM, need for insulin, or other notable adverse outcomes in either mother or baby.

The optimal HbA1c cutoff for GDM prediction in this population was 5.5% (sensitivity 60%, specificity 68.8%), while a value of 5.7% performed well for predicting insulin therapy among those who did develop GDM.

Outcomes: Does Early Detection Change Prognosis?

Despite a 36% prevalence of GDM in the cohort—higher than seen in many Western settings—most maternal and neonatal outcomes (preterm birth, birthweight, C-section rate, NICU admission) were quite similar between women with and without GDM. Noteworthy exceptions: GDM was associated with higher risks of preeclampsia, neonatal hypoglycemia, and neonatal respiratory distress.

Clinical Takeaway: How Can We Use This?

For clinicians, measuring HbA1c in the first trimester may provide an evidence-based tool to risk-stratify patients for GDM and tailor surveillance intensity. Asprosin, at least at this early gestation, doesn’t add clinical predictive value. Importantly, the study’s strong GDM management protocols may account for the comparable outcomes—the pragmatic benefit of early diagnosis is likely greatest in systems where intervention will follow.

Conclusion

Early-pregnancy HbA1c emerges as a practical, predictive marker for GDM and insulin need, while asprosin currently falls short in utility. With GDM rates climbing globally, evidence-based risk tools could help clinicians deliver more targeted, effective care from the first antenatal visit.

Key Points

First-trimester HbA1c is an independent predictor for future GDM and insulin requirement.

Asprosin levels in the first trimester do not predict GDM or adverse outcomes.

High GDM prevalence in this cohort did not translate to worse maternal or neonatal outcomes when managed with current protocols.

GDM raised the risk of preeclampsia, newborn low blood sugar, and respiratory distress.

Measuring HbA1c early in pregnancy could help identify women needing closer monitoring and proactive care.

Citation:

Sathaphone Inthavong, Phudit Jatavan, Sirinart Kumfu, Nipon Chattipakorn, Theera Tongsong. Associations of first-trimester HbA1c and asprosin with adverse pregnancy outcomes: a prospective cohort study. BMC Pregnancy and Childbirth. 2026; Article in Press. DOI: https://doi.org/10.1186/s12884-026-10101-8