Early pregnancy HbA1c as the first screening test for gestational diabetes: results from three prospective cohorts
Ponnusamy Saravanan, Mohan Deepa, Zain Ahmed, Uma Ram, Tarakeswari Surapaneni, Sailaja Devi Kallur, Papa Desari, Seshadri Suresh, Ranjit Mohan Anjana, Wesley Hannah, Chockalingam Shivashri, Saite Hemavathy, Nithya Sukumar, Wycliffe Kosgei, Astrid Christoffersen‐Deb, Vincent Kibet, John N. Hector, Gertrude Anusu, Nigel Stallard, Yonas Ghebremichael‐Weldeselassie, Norman Waugh, Sonak Pastakia, Viswanathan Mohan
Abstract
BACKGROUND: More than 90% of gestational diabetes cases are estimated to occur in low-income and middle-income countries (LMICs). Most current guidelines recommend an oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. The OGTT is burdensome, especially in LMICs, resulting in a high proportion of women not being screened. We aimed to develop a simple and effective screening strategy for gestational diabetes. METHODS: (venous and capillary point-of-care), either alone or as part of a composite risk score with age, BMI, and family history of diabetes, in predicting gestational diabetes at 24-28 weeks of gestation, in two LMICs (India and Kenya) and in a UK multi-ethnic population from the PRiDE study. A key secondary outcome was to assess whether an early pregnancy composite risk score can reduce the need for OGTTs. Gestational diabetes was diagnosed using current WHO criteria. FINDINGS: -alone model, the thresholds were 5·4% (rule in) and 4·9% (rule out) in India, 6·0% (rule in) and 5·2% (rule out) in Kenya, and 5·6% (rule in) and 5·2% (rule out) in the UK. INTERPRETATION: in LMICs. FUNDING: UK Medical Research Council and the Indian Department of Biotechnology.