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First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy

  • Gynecologic Endocrinology and Reproductive Medicine
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Abstract

Hyperglycaemia first detected during pregnancy is either gestational diabetes mellitus (GDM) or previous undiagnosed diabetes. We aimed to study if there were a first trimester fasting glycaemia (FTG) and a glycated haemoglobin (HbA1c) cut-off values associated with type 2 diabetes mellitus (T2DM) or abnormal glucose homeostasis (AGH) at the post-partum oral glucose tolerance test (OGTT) reclassification. We retrospectively studied a group of pregnant women from the Portuguese National Registry of GDM. Receiver-operating characteristic (ROC) curves were used to determine the best FTG and HbA1c cut-offs to predict T2DM and AGH. We studied 4068 women. The area under the ROC curves (AUC) for the association with T2DM was 0.85 (0.80–0.90) for FTG and 0.85 (0.80–0.91) for HbA1c. The best FTG cut-off for association with T2DM was 99 mg/dL: sensitivity 77.4%, specificity 74.3%, positive predictive value (PPV) 4.8%, and negative predictive value (NPV) 99.5%. The best HbA1c cut-off for association with T2DM was 5.4%: sensitivity 79.0%, specificity 80.1%, PPV 5.7%, and NPV 99.6%. The AUC for the association of FTG and HbA1c with AGH were 0.73 (0.70–0.76) and 0.71 (0.67–0.74), respectively. The best FTG cut-off for predicting AGH was 99 mg/dL: sensitivity 59.4%, specificity 76.2%, PPV 17.0%, and NPV 95.8%. The best HbA1c cut-off was 5.4%: sensitivity 48.7%, specificity 81.5%, PPV 17.8%, and NPV 95.1%. We suggest an FTG of 99 mg/dL and an HbA1c of 5.4% as the best cut-offs below which T2DM is unlikely to be present. Almost all patients with FTG < 99 mg/dL and HbA1c < 5.4% did not reclassify as T2DM. These early pregnancy cut-offs might alert the physician for the possibility of a previous undiagnosed diabetes and alert them to the importance of testing for it after delivery.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal

    Catarina Chaves, Filipe M. Cunha, Mariana Martinho, Susana Garrido, Margarida Silva-Vieira & Margarida Almeida

  2. Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal

    Catarina Estevinho, Anabela Melo, Odete Figueiredo & Ana Morgado

  3. Serviço de Endocrinologia do Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal

    Cláudia Nogueira

  4. Serviço de Obstetrícia, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Maria C. Almeida

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  1. Catarina Chaves
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  2. Filipe M. Cunha
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All authors have participated in conception and design, or analysis and interpretation of the data; drafting the article or revising it critically for important intellectual content; and approval of the final version.

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Correspondence to Catarina Chaves.

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Even though we do not have a formal approval from a Bioethics committee, this work refers to a retrospective observational study using data from a formal and well-established national gestational diabetes mellitus database. All data were anonymously collected and analysed.

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Chaves, C., Cunha, F.M., Martinho, M. et al. First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy. Arch Gynecol Obstet 305, 475–482 (2022). https://doi.org/10.1007/s00404-021-06107-6

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