Am J Perinatol 2016; 33(10): 977-982
DOI: 10.1055/s-0036-1581055
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

First Trimester Hemoglobin A1c Prediction of Gestational Diabetes

Sarah S. Osmundson
1   Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
Beinan S. Zhao
2   Division of Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California
Liza Kunz
3   Department of Obstetrics and Gynecology, Palo Alto Medical Foundation, Palo Alto, California
Elsie Wang
4   Department of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
Rita Popat
5   Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
Vani C. Nimbal
2   Division of Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California
Latha P. Palaniappan
4   Department of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Further Information

Publication History

13 October 2015

08 February 2016

Publication Date:
27 April 2016 (online)


Objective The objective of this study is to examine whether a first trimester hemoglobin A1c (A1C) of 5.7 to 6.4% predicts an abnormal second trimester oral glucose tolerance test (OGTT).

Methods We conducted a retrospective cohort study of all women screened with A1C through 13 6/7 weeks' gestation between January 1, 2011, and December 31, 2012. Prediabetic women (A1C of 5.7–6.4%) were compared with women with a normal first trimester A1C (< 5.7%). The primary outcome was an abnormal 2-hour, 75-g OGTT as defined by the International Association of Diabetes and Pregnancy Study Groups.

Results There were 2,812 women who met inclusion criteria of whom 6.7% (n = 189) were prediabetic. Women with prediabetes were more likely to have gestational diabetes mellitus (GDM) even after adjusting for potential confounders (29.1 vs. 13.7%; adjusted relative risk, 1.48; 95% confidence interval, 1.15–1.89). There were no statistically significant differences in secondary outcomes except that women with prediabetes had less excessive gestational weight gain. A prediabetic-range A1C in the first trimester was associated with a 13% sensitivity and a 94% specificity for predicting GDM

Conclusion Although women with prediabetes by first trimester A1C are significantly more likely to have GDM, the low sensitivity of an A1C in this range renders it a poor test to identify women who will develop GDM.

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