Korean J Lab Med.  2009 Apr;29(2):110-115. 10.3343/kjlm.2009.29.2.110.

The Relationship between the Timing of Gestational Diabetes Screening and HbA1c Level and Neonatal Outcome

• Choi YJ
• Kahng J
• Bin JH
• Lee HS
• Lee JH
• Kim SY
• Sung IK
• Lee WB
• Chun CS

• KMID: 854966
• DOI: http://doi.org/10.3343/kjlm.2009.29.2.110

Abstract

BACKGROUND
The aim of this study was to observe clinical outcomes of the mother and her infant who were possibly exposed to high blood glucose at least 2-3 months in the early and midterm pregnancy by checking gestational weeks (GW) and the first HbA1c level at initial diagnosis of gestational diabetes (GDM). METHODS: A total of 107 GDM patients and their newborns were subject of this study. GDM patients were newly diagnosed at the Holy Family Hospital of Catholic University from January 2003 until December 2007 and continuously managed in the diabetes center. Patients medical records were retrospectively reviewed to evaluate GW and HbA1c level at the time of diagnosis, and clinical outcomes of mother and newborn baby. RESULTS: The proportion of subjects who had been diagnosed of having GDM according to GW was 7.5%, in less than 24th week of pregnancy; 55.1% in the 24-28th week; 28.0% in the 29-32nd week; and 9.4% 33rd week or more. There were 39 out of 107 subjects (36.4%) with HbA1c levels > or =6.5% and 26 out of 39 subjects (24.3%) with HbA1c levels > or =7.0%. In clinical outcomes of newborn by HbA1c levels, the frequency of delivery of large for gestational age (LGA) infant was higher in mothers diagnosed with GDM after 29th week of pregnancy or with HbA1c levels 7.0% or more (P<0.001). CONCLUSIONS: If the screening test for gestational DM was delayed, HbA1c level and the risk for LGA seemed to be higher, so it may be necessary to screen GDM no later than 24th week of pregnancy.

Keyword

Gestational diabetes mellitus; Neonatal outcome; Screening test; HbA1c

MeSH Terms

Adult
Diabetes, Gestational/*diagnosis
Female
Gestational Age
Hemoglobin A, Glycosylated/*analysis
Humans
Infant, Newborn
Mass Screening
Pregnancy
Retrospective Studies
Time Factors

Reference

1.Buchanan TA., Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005. 115:485–91.

2.Galerneau F., Inzucchi SE. Diabetes mellitus in pregnancy. Obstet Gynecol Clin North Am. 2004. 31:907–33.

3.Metzger BE. Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol. 2007. 50:972–9.

4.Nold JL., Georgieff MK. Infants of diabetic mothers. Pediatr Clin North Am. 2004. 51:619–37.

5.Damm P., Kuhl C., Bertelsen A., M⊘lsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol. 1992. 167:607–16.

6.Metzger BE., Cho NH., Roston SM., Radvany R. Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus. Diabetes Care. 1993. 16:1598–605.

7.O'Brien K., Carpenter M. Testing for gestational diabetes. Clin Lab Med. 2003. 23:443–56.

8.Radder JK., van Roosmalen J. HbA1c in healthy pregnant women. Neth J Med. 2005. 63:256–9.

9.Choi YS., Yoon YH., Chung WS., Choi TY., Kim CW. A study on the usefulness of HbA1c for diagnosis in patients with diabetes mellitus. Korean J Clin Pathol. 1991. 11:31–9. (최영식, 윤영호, 정화순, 최태열, 김춘원. 당뇨병 환자 진단에 있어서 HbA1c의 유용성에 관한 연구. 대한임상병리학회지 1991;11: 31-9.).

10.Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979. 28:1039–57.

11.Byun YJ., Kim HS. Recent advances in gestational diabetes mellitus. Korean J Obstet Gynecol. 2007. 50:1445–54. (변영지및김행수. 임신성당뇨병의최신지견. 대한산부인과학회지 2007;50: 1445-54.).

12.Park JH., Song HJ., Choun JK., Cho JJ., Paek YJ., Park KH, et al. Risk factors for gestational diabetes mellitus. Korean J Obes. 2005. 14:178–85. (박지회, 송홍지, 천정기, 조정진, 백유진, 박경희등. 임신성당뇨병의위험인자. 대한비만학회지 2005;14: 178-85.).

13.Nahum GG., Huffaker BJ. Correlation between first and early third trimester glucose screening test results. Obstet Gynecol. 1990. 76:709–13.

14.Bhattacharya SM. Glucose screening test results in first and early third trimester of pregnancy: is there any correlation? J Obstet Gynaecol Res. 2002. 28:304–7.

15.Nathan DM., Singer DE., Hurxthal K., Goodson JD. The clinical information value of the glycosylated hemoglobin assay. N Engl J Med. 1984. 310:341–6.

16.Agarwal MM., Dhatt GS., Punnose J., Koster G. Gestational diabetes: a reappraisal of HBA1c as a screening test. Acta Obstet Gynecol Scand. 2005. 84:1159–63.

17.Yogev Y., Hod M. Use of new technologies for monitoring and treating diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007. 34:241–53.

18.Gandhi RA., Brown J., Simm A., Page RC., Idris I. HbA1c during pregnancy: its relationship to meal related glycaemia and neonatal birth weight in patients with diabetes. Eur J Obstet Gynecol Reprod Biol. 2008. 138:45–8.

19.Kalhan SC., Parimi PS, et al. Pregnancy complicated by diabetes mellitus. Fanaroff AA, Martin RJ, editors. Neonatal perinatal medicine: diseases of fetus and infant. 7th ed.Philadelphia: Mosby;2002. p. 1357–62.

20.Petry CD., Eaton MA., Wobken JD., Mills MM., Johnson DE., Georgieff MK. Iron deficiency of liver, heart, and brain in newborn infants of diabetic mothers. J Pediatr. 1992. 121:109–14.

21.Rizzo TA., Metzger BE., Dooley SL., Cho NH. Early malnutrition and child neurobehavioral development: insights from the study of children of diabetic mothers. Child Dev. 1997. 68:26–38.

22.Silverman BL., Metzger BE., Cho NH., Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care. 1995. 18:611–7.

23.Gold AE., Reilly R., Little J., Walker JD. The effect of glycemic control in the pre-conception period and early pregnancy on birth weight in women with IDDM. Diabetes Care. 1998. 21:535–8.

24.Balaji V., Madhuri BS., Ashalatha S., Sheela S., Suresh S., Seshiah V. A1C in gestational diabetes mellitus in Asian Indian women. Diabetes Care. 2007. 30:1865–7.

25.Meyer WJ., Carbone J., Gauthier DW., Gottmann DA. Early gestational glucose screening and gestational diabetes. J Reprod Med. 1996. 41:675–9.

26.Kuzuya T., Nakagawa S., Satoh J., Kanazawa Y., Iwamoto Y., Kobayashi M, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. Diabetes Res Clin Pract. 2002. 55:65–85.

27.Maegawa Y., Sugiyama T., Kusaka H., Mitao M., Toyoda N. Screening tests for gestational diabetes in Japan in the 1st and 2nd trimester of pregnancy. Diabetes Res Clin Pract. 2003. 62:47–53.