PREDICTIVE VALUE OF FIRST TRIMESTER GLYCOSYLATED HEMOGLOBIN (HBA1C) IN GESTATIONAL DIABETES MELLITUS

Background: Gestational diabetes mellitus(GDM), is "any degree of glucose intolerance with onset or first recognition during pregnancy." GDM is steadily rising and increases the risk of adverse maternal and perinatal outcomes. Early diagnosis and treatment can decrease its consequences. The aim of this study was to find the predictive value of HbA1c level in GDM and to compare the mean HbA1c level among GDM and non GDM. Methods: A hospital based prospective cohort study was done for a duration of 16 months which included 786 cases visiting in Out Patient Department of obstetrics and gynecology of Kathmandu Medical College. First trimester HbA1c level report were documented. Gestational diabetes mellitus was diagnosed by National Institute For Health And Care Excellence(NICE) guideline at 24 to 28 weeks of gestation. Mean HbA1c level was compared between GDM and non GDM group. ROC curve was used to predict the cut off value of HbA1C. Results: Among 786 cases 94 were diagnosed as GDM. The prevalence of GDM was “12%(95% C.I:9.8%-14.4%). The area under the curve(AUC) of HbA1c of GDM was good predictor of GDM with 0.601 with sensitivity of 69.1% and specificity of 41.2%. The cutoff value of HbA1c was 5.04. The mean HbA1c level was significantly higher than non gestational diabetes mellitus(NGDM) group (5.28 ± 0.453 and 5.11 ± 0.412(p-value 5.04% of first trimester HbA1c can be used for screening of GDM. The mean HbA1c level in GDM was 5.28 ± 0.453(P-value