Evaluation of HbA1c trend analysis as a Prognostic Tool in gestational diabetes
DOI:
https://doi.org/10.5281/zenodo.22812548Keywords:
HbA1c, gestational diabetes, prognostic marker, glycated haemoglobin, pregnancy outcomesAbstract
Background: Glycated haemoglobin (HbA1c) reflects mean glycaemia over the preceding eight to twelve weeks and, unlike the oral glucose tolerance test (OGTT), can be measured without fasting, making it an attractive candidate marker for prognostic surveillance in gestational diabetes mellitus (GDM).
Objective: This review evaluates the evidence for HbA1c, and particularly HbA1c trend across pregnancy, as a prognostic tool for maternal and neonatal outcomes in GDM, in comparison with the OGTT-based diagnostic standard.
Methods: We synthesized cohort studies, randomized treatment trials, and guideline documents addressing HbA1c reference intervals in pregnancy, early-pregnancy HbA1c screening thresholds, HbA1c trend and adverse pregnancy outcomes, and postpartum diabetes risk stratification.
Findings: HbA1c declines physiologically across normal pregnancy, so trend interpretation requires trimester-specific reference values; an early-pregnancy threshold of 5.9% (41 mmol/mol) identifies a subgroup at increased risk of subsequent GDM diagnosis and adverse outcomes; and antenatal glycaemic trajectory, including HbA1c, is associated with postpartum glucose intolerance and long-term type 2 diabetes risk.
Conclusions: HbA1c trend analysis is a useful complementary, non-fasting prognostic tool for risk-stratifying women with GDM before, during, and after pregnancy, but it should be interpreted against pregnancy-specific reference trajectories and alongside the OGTT rather than as a substitute for it.
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