Abstract: Objective: To analyze the predictive value of first trimester HbA1c test in early detection of gestational diabetes mellitus. And, to study the association of high-risk factors with raised HbA1c levels in patients with gestational diabetes mellitus.
Method: The study was a hospital based observational prospective study conducted in the department of Obstetrics and Gynecology of tertiary care hospital, GMERS Medical College and Hospital, Gotri, Vadodara, Gujarat, India over a 10 months period from October 2022 to August 2023.The study population comprised of 150 pregnant women with singleton gestation of less than 12 weeks. HbA1c test and 75gm OGTT (Oral Glucose Tolerance Test) / DIPSI test (Diabetes in Pregnancy Study group of India) were done in all the women in their first trimester excluding patients with HbA1c≥6.5% or DIPSI ≥140 mg/dL. Further, a second trimester (24-28 weeks) and third trimester OGTT (32-34 weeks) were done to detect GDM using WHO 2013 criteria.
Result: Using the cutoff value of 5.3% HbA1c was able to detect 16 (69.6%) out of 23 cases of GDM. The area under the ROC curve was 0.82 (95% CI 0.73-0.91; p<0.01). Patients with an HbA1c >5.3% had a 3.05-fold risk of developing GDM. For the optimal cut-off of the ROC analysis the sensitivity was 69.6% (95% CI- 47.1%-86.8%), the specificity was 77.2% (95% CI – 68.9%-84.1%), the positive predictive value was 35.6% (95% CI-26.6% -45.6%) and the negative predictive value was 93.3% (88.2%-96.3%). Overall diagnostic accuracy of HbA1c value >5.3% was 76.0% (95% CI-88.2%-96.2%).
Conclusion: The present study results suggested that HbA1c can be an appropriate biomarker for GDM prediction, probably not in isolation, but rather as a part of a multi-marker algorithm for high-and low-risk populations.
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