To Study First Trimester Hba1c As A Screening Test ForGestational Diabetes Mellitus

Abstract

Pregnancy triggers several physiological changes to fulfil the escalating energy requirements of both the mother and the foetus. Insulin resistance significantly rises by 50-70% in both pregnancies without GDM and pregnancies with GDM. The HbA1c test now exhibits enhanced analytical stability due to increased standardisation between different assays and reduced variation in the pre analytical phase. Higher levels of maternal HbA1c are directly linked to a higher occurrence of adverse outcomes.

Aim & Objectives: To assess the validity of HbA1c as screening tool for Gestational Diabetes in the First Trimester Pregnancy.

To test the validity or sensitivity and specificity of first trimester HbA1c screening for Gestational diabetes in pregnant women attending the antenatal clinic.

Materials And Methods: A cohort of 100 pregnant women in first trimester attending the antenatal clinic in the department of Obstetrics and Gynecology in Vinayaka Mission’s Kirupanada Variyar Medical College and Hospital, Salem were enrolled in a 17 months study. After getting approval from the institutional ethics committee, First-trimester pregnant women who satisfy the inclusion criteria will be employed for HbA1c testing along with FBS. Patients further will be evaluated with repeat HbA1c and 75gms 2hr DIPSI, followed by 75gms oral glucose tolerance test to confirm the diagnosis of GDM using WHO-2013 criteria in second and third trimester. These women will be followed till delivery to know the incidence of gestational diabetes and its effects on fetal maternal outcome. Statistical analysis as conducted using SPSS 23.0 software.

Results: The incidence of GDM in the present study was 46%.Among the 46 GDM participants, 9 exhibited a Negative OGCT result, while 37 showed a Positive OGCT result. GDM was associated with an increased frequency of both instrumental vaginal deliveries (3 versus 1) and cesarean sections (15 versus 5), with a statistically significant overall association observed (P = 0.005).Statistical analysis produced P-values of 0.08, 0.81, and 0.40 for diabetic, non-diabetic, and prediabetic groups, respectively, highlighting varying associations between HbA1c levels and foetal outcomes in this cohort. NICU admission was necessary for 13% of the infants, while 87% did not require such admission.

Conclusion: HbA1c as a screening tool for gestational diabetes mellitus (GDM) during the first trimester appears promising, correlating significantly with subsequent OGCT results and maternal complications. The prevalence of GDM in the cohort was notable at 46%. The study underscores the effectiveness of early HbA1c testing in identifying at-risk pregnancies, emphasizing its potential role in enhancing prenatal care strategies and maternal-fetal health outcomes.