Gestational Diabetes Mellitus GDM GDM diagnosis GDM screening HbA1c in GDM HbA1c predicts GDM in first trimester In middle pregnancy, HbA1c levels decline HbA1c levels increase in the third trimester

1. Dr. Arun Sharma
Manager, Medical Affairs
Mankind Pharma Ltd.

2. According to a new study published in
the Scientific Reports, Hemoglobin A1C
(HbA1c) measured in the first trimester
improved the prediction of gestational
diabetes mellitus (GDM)

4. • HbA1cserves as an indicator of blood glucose control in the prior 3 4
months, may be an avenue for earlier identification of women at
risk for GDM
• However, while HbA1c is currently used among high-risk women at
the first prenatal visit to identify women with overt type 2
diabetes (T2D), it is not currently used to screen for GDM
• According to the authors, a few prior studies have examined if
HbA1c measured in the first trimester is useful for early prediction
of GDM; however, these studies have been among high-risk
populations only.

5. • Records from the NICHD Fetal Growth Study*, between 2009 and
2013 were analyzed
• HbA1c test results from 107 women who later developed GDM
were compared to test results from 214 women who did not
develop the condition
• Most of the women had tests at four intervals during
pregnancy: early (weeks 8-13), middle (weeks 16-22 and 24-29)
and late (weeks 34-37).
*A large observational study that recruited more than 2,000 low-risk pregnant women from 12 U.S. clinical sites
Methodology

7. Women who went on to develop gestational
diabetes had higher HbA1c levels (an average
of 5.3 %), compared to those without GDM (an
average HbA1c level of 5.1 %)
Key Finding 1

8. Each .1 % increase in HbA1c above 5.1
percent in early pregnancy was
associated with a 22 % higher risk for
gestational diabetes
Key Finding 2

9. In middle pregnancy, HbA1c levels
declined for both groups
Key Finding 3

10. However, HbA1c levels increased in the final
third of pregnancy, which is consistent with the
decrease in sensitivity to insulin that often
occurs during this time period
Key Finding 4

11. With increasing levels of HbA1c, GDM risk
increased significantly and in a linear fashion
Key Finding 5

13. The study highlights the potential important
clinical utility of HbA1c measurement in the
first trimester of pregnancy, even among
low-risk women

14. GDM prediction was significantly improved with
the inclusion of HbA1c over conventional risk
factors suggesting that it could be used to
improve early risk-stratification and screening

15. Hyperglycemia even among women
without pre-pregnancy diabetes may be
important for the development of GDM

16. Source: https://www.nature.com/articles/s41598-018-30833-8