Dataset Information

The diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus among Chinese pregnant individuals.

ABSTRACT:

Background

This study aims to investigate the diagnostic value of the glycated hemoglobin (HbA1c) test for detecting gestational diabetes mellitus (GDM) in pregnant Chinese patients.

Methods

We enrolled a large cohort of 19,261 pregnant individuals who had both oral glucose tolerance test (OGTT) and HbA1c test between 24 and 28 weeks of gestation in a large Chinese tertiary hospital consecutively from 2013 to 2018. We used Pearson's correlation test to evaluate the correlation between OGTT and HbA1c. The diagnostic accuracy of HbA1c for GDM was examined with the receiver operating characteristic curve, using OGTT as the reference standard.

Results

A total of 3,547 (18.42%) women were diagnosed with GDM. HbA1c was positively, but only weakly correlated with the fasting, 1-hour glucose, and 2-hour glucose (r=0.31, 0.24, and 0.25, respectively, all P<0.001). The area under the curve of the HbA1c level for detecting GDM was 0.664 (95% CI: 0.653-0.674, P<0.01). The optimal cut-off point of HbA1c for GDM diagnosis was determined at 5.0% (31 mmol/mol), which yielded a sensitivity of 60.1%, a specificity of 65.3%, a positive predictive value of 28.1%, and a negative predictive value of 87.9%.

Conclusions

HbA1c test is weakly correlated with OGTT during pregnancy, and it offers only limited value in diagnosing GDM among Chinese pregnant individuals.

SUBMITTER: Lai Y

PROVIDER: S-EPMC7475463 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

The diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus among Chinese pregnant individuals.

Lai Yi Y Chen Hanxiao H Du Ze Z Zhou Shu S Xu Wenming W Li Tao T

Annals of translational medicine 20200801 16

<h4>Background</h4>This study aims to investigate the diagnostic value of the glycated hemoglobin (HbA1c) test for detecting gestational diabetes mellitus (GDM) in pregnant Chinese patients.<h4>Methods</h4>We enrolled a large cohort of 19,261 pregnant individuals who had both oral glucose tolerance test (OGTT) and HbA1c test between 24 and 28 weeks of gestation in a large Chinese tertiary hospital consecutively from 2013 to 2018. We used Pearson's correlation test to evaluate the correlation bet ...[more]

PMID: 32953814

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Project description:BackgroundTo investigate the accuracy of screening tests for gestational diabetes mellitus (GDM) in Southeast Asian pregnant women.MethodsWe searched PubMed (MEDLINE), Web of Science, Cochrane Library, ClinicalTrials.gov, Google Scholar, and Google for relevant articles published in English up to November 2018 using search terms related to GDM, screening tests for GDM and diagnostic performance. The studies were independently screened and selected by both authors. The methodological quality of the included studies was independently assessed by quality assessment of diagnostic accuracy studies 2. A hierarchical summary receiver operating characteristic (HSROC) model was created to estimate the HSROC curve. The summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated in a meta-analysis using bivariate random-effects model.ResultsA total of 19 studies were included in which the 100 g oral glucose tolerance test (OGTT) and 75 g OGTT were the two common reference standards for diagnosis of GDM. Most points of diagnostic performance in the HSROC 50 g GCT curve compared with the 100 g OGTT reference standard were clustered in the upper left-hand quadrant. The pooled sensitivity and specificity of the 50 g GCT were 79% (95% confidence interval [CI] 64%-89%) and 74% (95% CI 59%-85%), respectively. For the 75 g OGTT reference standard, the non-fasting 2-hour plasma glucose showed quite similar sensitivity the 50 g GCT compared with the 100 g OGTT reference standard. The pooled sensitivities and specificities of the fasting plasma glucose and hemoglobin A1c were 81% (95% CI 76%-86%) and 70% (95% CI 67%-72%), and 80% (95% CI 66%-90%) and 69% (95% CI 58%-78%), respectively.ConclusionOur findings indicate that the 50 g GCT using the threshold of 140 mg/dL is a good screening test for identifying GDM at 24 to 28 weeks' gestational age for both high-risk and universal screening strategies in Southeast Asian countries. The non-fasting 2-hour PG, fasting plasma glucose or hemoglobin A1c are alternative choices for screening.

Project description:Gestational diabetes mellitus (GDM) is closely related to adverse pregnancy outcomes and other diseases. Early intervention in pregnant women who are at high risk of developing GDM could help prevent adverse health consequences. The study aims to develop a simple model using the stacking ensemble method to predict GDM for women in the first trimester based on easily available factors. We used the data from the Chinese Pregnant Women Cohort Study from July 2017 to November 2018. A total of 6,848 pregnant women in the first trimester were included in the analysis. Logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost) were considered as base learners. Optimal feature subsets for each learner were chosen by using recursive feature elimination cross-validation. Then, we built a pipeline to process imbalance data, tune hyperparameters, and evaluate model performance. The learners with the best hyperparameters were employed in the first layer of the proposed stacking method. Their predictions were obtained using optimal feature subsets and served as meta-learner's inputs. Another LR was used as a meta-learner to obtain the final prediction results. Accuracy, specificity, error rate, and other metrics were calculated to evaluate the performance of the models. A paired samples t-test was performed to compare the model performance. In total, 967 (14.12%) women developed GDM. For base learners, the RF model had the highest accuracy (0.638 (95% confidence interval (CI) 0.628-0.648)) and specificity (0.683 (0.669-0.698)) and lowest error rate (0.362 (0.352-0.372)). The stacking method effectively improved the accuracy (0.666 (95% CI 0.663-0.670)) and specificity (0.725 (0.721-0.729)) and decreased the error rate (0.333 (0.330-0.337)). The differences in the performance between the stacking method and RF were statistically significant. Our proposed stacking method based on easily available factors has better performance than other learners such as RF.

Project description:BackgroundGestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes such as preeclampsia and macrosomia. Women with polycystic ovary syndrome (PCOS) are at increased risk of developing GDM. Today, GDM is diagnosed by oral glucose tolerance test (OGTT), a rather cumbersome test for the women and health care system. The objectives of this study were to investigate whether HbA1c in first trimester of pregnancy could be used as a screening test for GDM in first trimester and throughout pregnancy in order to reduce the number of OGTTs, and whether it could predict preeclampsia and macrosomia in women with PCOS.MethodsPost hoc analyses of data from 228 women from a prospective, randomised, multicenter study comparing metformin to placebo from first trimester to delivery. Fasting and 2-h plasma glucose were measured during a 75 g OGTT in first trimester, gestational week 19 and 32 as well as fasting plasma glucose in gestational week 36. GDM was diagnosed by WHO criteria from 1999 in first trimester and throughout pregnancy and by modified IADPSG criteria (i.e. lacking the 1-h plasma glucose value) in first trimester. The diagnostic accuracy was assessed by logistic regression and ROC curve analysis.ResultsThe area under the ROC curve for first trimester HbA1c for screening of GDM diagnosed by WHO criteria in first trimester was 0.60 (95 % CI 0.44-0.75) and 0.56 (95 % CI 0.47-0.65) for GDM diagnosed throughout pregnancy. Only 2.2 % (95 % CI 0.7-5.1 %) of the participants could have avoided OGTT. HbA1c was not statistically significantly associated with GDM diagnosed by modified IADPSG criteria in first trimester. However, first trimester HbA1c was statistically significantly associated with preeclampsia. Both HbA1c and GDM by WHO criteria in first trimester, but not by IADPSG, were negatively associated with birth weight.ConclusionFirst trimester HbA1c can not be used to exclude or predict GDM in women with PCOS, but it might be better to predict preeclampsia than the GDM diagnosis.

Project description:BackgroundLiver plays an important role in maintaining glucose homeostasis. We aimed to examine the associations of liver enzymes and hepatic steatosis index (HSI, a reliable biomarker for non-alcoholic fatty liver disease) in early pregnancy with subsequent GDM risk, as well as the potential mediation effects of lipid metabolites on the association between HSI and GDM.MethodsIn a birth cohort, liver enzymes were measured in early pregnancy (6-15 gestational weeks, mean 10) among 6,860 Chinese women. Multivariable logistic regression was performed to examine the association between liver biomarkers and risk of GDM. Pearson partial correlation and least absolute shrinkage and selection operator (LASSO) regression were conducted to identify lipid metabolites that were significantly associated with HSI in a subset of 948 women. Mediation analyses were performed to estimate the mediating roles of lipid metabolites on the association of HSI with GDM.ResultsLiver enzymes and HSI were associated with higher risks of GDM after adjustment for potential confounders, with ORs ranging from 1.42 to 2.24 for extreme-quartile comparisons (false discovery rate-adjusted P-trend ≤0.005). On the natural log scale, each SD increment of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, and HSI was associated with a 1.15-fold (95% CI: 1.05, 1.26), 1.10-fold (1.01, 1.20), 1.21-fold (1.10, 1.32), 1.15-fold (1.04, 1.27), and 1.33-fold (1.18, 1.51) increased risk of GDM, respectively. Pearson partial correlation and LASSO regression identified 15 specific lipid metabolites in relation to HSI. Up to 52.6% of the association between HSI and GDM risk was attributed to the indirect effect of the HSI-related lipid score composed of lipid metabolites predominantly from phospholipids (e.g., lysophosphatidylcholine and ceramides) and triacylglycerol.ConclusionsElevated liver enzymes and HSI in early pregnancy, even within a normal range, were associated with higher risks of GDM among Chinese pregnant women. The association of HSI with GDM was largely mediated by altered lipid metabolism.

Dataset Information

The diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus among Chinese pregnant individuals.

Background

Methods

Results

Conclusions

Publications

The diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus among Chinese pregnant individuals.

Similar Datasets

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