Evaluation of First Trimester Fasting Blood Glucose, HOMA-IR and HbA1c in Prediction of Gestational Diabetes Mellitus in Non-Obese Pregnant Women: A Retrospective Study

Year 2022, Volume: 6 Issue: 3, 267 - 273, 29.12.2022

Mehmet Mete Kırlangıç Belfin Nur Arici Halici

https://doi.org/10.25048/tudod.1198697

Cited By: 3

Abstract

Aim: Gestational Diabetes Mellitus (GDM) is the most common endocrine complication in pregnancy with fetomaternal comorbidities. It is aimed to evaluate fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), and hemoglobin A1c (HbA1c) values in the first trimester in non-obese pregnant women for early detection of GDM.
Material and Methods: Pregnant women with first-trimester FBG, HOMA-IR, HbA1c values, and second-trimester OGTT results were scanned from the hospital database. First-trimester height, weight, age and gestational weeks were also recorded. The presence of Body Mass Index (BMI) over 30 kg/m2, chronic and systemic disease and history of G(DM) were not included in the study. ROC analysis was performed on FBG, HOMA-IR, and HbA1c.
Results: This retrospective study was conducted between 01/01/2021, and 01/01/2022 in Tuzla State Hospital Gynecology and Obstetrics Clinic. 131 pregnant women who met the inclusion criteria were reached. Twenty of pregnant women were evaluated as GDM positive(+). Age, height, weight, BMI, gestational week, and nulliparity were observed to be similar between the groups. FBG, insulin, HOMA-IR, and HbA1c values were higher in the group with GDM. As a result of ROC analysis, those with an FBG value of 88,5 mg/dl (sensitivity 68.2%, specificity 68.2%), a HOMA-IR value of 2.24 (sensitivity 63.6%, specificity 64.5%), and a HbA1c (sensitivity 68.2%, specificity 66.7%) value of over 5.25% were observed to be at risk for GDM.
Conclusion: It has shown that pregnant women with high first trimester FBG, HOMA-IR and HbA1c have a high risk for GDM and can be used as a predictor of GDM.

Keywords

First Trimester, GDM, GDM, GDM, HOMA-IR, HOMA-IR, HOMA-IR, HOMA-IR, HbA1c, HbA1c, HbA1c, Prediction

Obez Olmayan Gebe Kadınlarda Gestasyonel Diabetes Mellitus Tahmininde Birinci Trimester Açlık Kan Şekeri, HOMA-IR ve HbA1c Analizi: Bir Retrospektif Çalışma

Abstract

Amaç: Gestasyonel Diabetes Mellitus (GDM), fetomaternal komorbiditeleri olan gebelikte en sık görülen endokrin komplikasyondur. GDM'nin erken tanısı için obez olmayan gebelerde ilk trimesterde açlık kan şekeri (AKŞ), insülin direnci homeostaz modeli değerlendirmesi (HOMA-IR), Hemoglobin A1c (HbA1c) değerlerinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Birinci trimester AKŞ, HOMA-IR, HbA1c değerleri ve ikinci trimester OGTT sonuçları olan gebeler hastane veri tabanından tarandı. İlk trimester boyu, kilosu, yaşı ve gebelik haftaları da kaydedildi. Vücut kütle indeksi (VKİ) 30 kg/m2'nin üzerindekiler, kronik ve sistemik hastalığı ve (GDM) öyküsü olanlar çalışmaya dahil edilmedi. ROC analizi AKŞ, HOMA-IR, HbA1c üzerinde yapıldı.
Bulgular: Bu retrospektif çalışma 01/01/2021-01/01/2022 tarihleri arasında Tuzla Devlet Hastanesi Kadın Hastalıkları ve Doğum Kliniği'nde yapıldı. Dahil edilme kriterlerini karşılayan 131 hamile kadına ulaşıldı. Gebelerin yirmisi GDM pozitif (+) olarak değerlendirildi. Yaş, boy, kilo, VKİ, gebelik haftası, nulliparite gruplar arasında benzer olarak gözlendi. AKŞ, insülin, HOMA-IR, HbA1c değerleri GDM'li grupta daha yüksekti. ROC analizi sonucunda, AKŞ değeri 88,5 mg/dl (sensitivite %68.2, spesifite %68.2), HOMA-IR değeri 2.24 (sensitivite %63.6, spesifite %64.5) ve HbA1c değeri %5.25'in (sensitivite %68.2, spesifite %66.7) üzerinde olanların GDM için risk altında olduğu gözlenmiştir.
Sonuç: Birinci trimester yüksek AKŞ, HOMA-IR ve HbA1c olan gebelerin GDM için yüksek risk taşıdığını ve GDM'nin bir göstergesi olarak kullanılabileceğini göstermiştir.

Keywords

FBG, FBG, GDM, GDM, GDM, GDM, HOMA-IR, HOMA-IR, HOMA-IR, HOMA-IR, HbA1c, HbA1c, HbA1c, HbA1c

References

• 1. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Sheridan B, Hod M, et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes. 2008.
• 2. Popova P, Kravchuk E, Gerasimov A, Shelepova E, Tsoi U, Grineva E, editors. The new combination of risk factors determining a high risk of gestational diabetes mellitus. Endocrine Abstracts; 2012: Bioscientifica.
• 3. Association AD. Standards of medical care in diabetes—2010. Diabetes care. 2010;33(Supplement_1):S11-S61.
• 4. Clayton Jr W, Agarwal N, Wang L, Jagasia S. Clinical markers implying the need for treatment in women with gestational diabetes mellitus. Endocrine Practice. 2012;18(1):62-5.
• 5. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. New England journal of medicine. 2005;352(24):2477-86.
• 6. Yogev Y, Chen R, Hod M, Coustan D, Oats J, Metzger B, et al. Hyperglycemia and adverse pregnancy outcome (HAPO) study: preeclampsia. American journal of obstetrics and gynecology. 2010;202(3).
• 7. Colomiere M, Permezel M, Lappas M. Diabetes and obesity during pregnancy alter insulin signalling and glucose transporter expression in maternal skeletal muscle and subcutaneous adipose tissue. J Mol Endocrinol. 2010;44(4):213-23.
• 8. Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstetrics and gynecology. 2010;115(3):597.
• 9. Yuen L, Saeedi P, Riaz M, Karuranga S, Divakar H, Levitt N, et al. Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice. 2019;157:107841.
• 10. Agarwal M, Hughes P, Punnose J, Ezimokhai M, Thomas L. Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins. Diabetes research and clinical practice. 2001;51(1):67-73.
• 11. Alptekin H, Çizmecioğlu A, Işık H, Cengiz T, Yildiz M, Iyisoy MS. Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR. Journal of endocrinological investigation. 2016;39(5):577-83.
• 12. Diabetes IAo, Panel PSGC. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes care. 2010;33(3):676-82.
• 13. Moyer VA, Force* UPST. Screening for gestational diabetes mellitus: US Preventive Services Task Force recommendation statement. Annals of internal medicine. 2014;160(6):414-20.
• 14. Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2003;109(1):41-4.
• 15. Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Gestational diabetes mellitus manifests in all trimesters of pregnancy. Diabetes research and clinical practice. 2007;77(3):482-4.
• 16. Fong A, Serra AE, Gabby L, Wing DA, Berkowitz KM. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. American journal of obstetrics and gynecology. 2014;211(6):641. e1-. e7.
• 17. Valadan M, Bahramnezhad Z, Golshahi F, Feizabad E. The role of first-trimester HbA1c in the early detection of gestational diabetes. BMC Pregnancy and Childbirth. 2022;22(1):1-7.
• 18. Benaiges D, Flores-Le Roux JA, Marcelo I, Mañé L, Rodríguez M, Navarro X, et al. Is first-trimester HbA1c useful in the diagnosis of gestational diabetes? Diabetes research and clinical practice. 2017;133:85-91.
• 19. Poo ZX, Wright A, Ruochen D, Singh R. Optimal first trimester HbA1c threshold to identify Singaporean women at risk of gestational diabetes mellitus and adverse pregnancy outcomes: A pilot study. Obstetric Medicine. 2019;12(2):79-84.
• 20. Song S, Zhang Y, Qiao X, Duo Y, Xu J, Peng Z, et al. HOMA‐IR as a risk factor of gestational diabetes mellitus and a novel simple surrogate index in early pregnancy. International Journal of Gynecology & Obstetrics. 2022;157(3):694-701.
• 21. Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, et al. Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance. Diabetologia. 2019;62(11):2118-28.
• 22. Ozcimen EE, Uckuyu A, Ciftci FC, Yanik FF, Bakar C. Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment–insulin resistance index in the first trimester. Gynecological Endocrinology. 2008;24(4):224-9.
• 23. Temming LA, Tuuli MG, Stout MJ, Macones GA, Cahill AG. Maternal and perinatal outcomes in women with insulin resistance. American journal of perinatology. 2016;33(08):776-80.
• 24. Powe CE. Early pregnancy biochemical predictors of gestational diabetes mellitus. Current diabetes reports. 2017;17(2):1-10.
• 25. Lippi G, Targher G. Glycated hemoglobin (HbA1c): old dogmas, a new perspective? Clinical chemistry and laboratory medicine. 2010;48(5):609-14.