8 They found that early A1C screening was somewhat predictive of early GD, where women who had GD had higher median A1C values compared to women without GD. To investigate diagnosing early GD using A1C, Venkatesh and colleagues conducted a retrospective study using the medical records of 243 high-risk women who had had both an A1C and a two-step test before or during the second trimester. “Diabetes screening in early pregnancy aims to identify women at risk of complications so they can make healthy lifestyle changes or begin treatment with medications however, there are no set standards for early GD screening in the US.” Currently, the ADA and IADPSG allow use of A1C for testing and screening, but the ADA does not recommend using A1C alone. In terms of screening for early GD, it is unclear which test performs best. 3,5–7 However, there are no established A1C guidelines in early pregnancy. In contrast, the A1C test can be added to the usual prenatal blood panel.īecause of the complications associated with diabetes in pregnancy, the American College of Obstetricians and Gynecologists, the American Diabetes Association (ADA), and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) all recommend early diabetes screening in pregnant women with risk factors for diabetes. The traditional two-step approach to testing can be difficult for pregnant women, as the test is time-consuming and requires women to fast and drink a nauseating sugary liquid.
According to the committee, an A1C measure of more than or equal to 6.5 percent is indicative of diabetes, while a range between 6 percent and 6.4 percent is considered prediabetes, meaning a person is at high risk of developing diabetes. Thus, an A1C test measures the percentage of hemoglobin A bound with glucose, known as glycated hemoglobin (A1C), over the past two to three months. 4 In the blood, glucose can bind to the hemoglobin A molecule in red blood cells for up to 120 days. Recommended by the International Expert Committee in 2009, the A1C test is a blood test now commonly used for diabetes screening and monitoring in non-pregnant people.
“The dilemma is, how do you diagnose diabetes in early pregnancy? Do you need to go through a two-step process like the way we diagnose gestational diabetes later in pregnancy, or can you actually use an A1C in pregnancy?” Hemoglobin A1C tests Kartik Venkatesh, a high-risk obstetrician at Ohio State Wexner Medical Center.
“Many women are showing up pregnant with clear risk factors for insulin resistance and diabetes, but they were not screened before pregnancy,” says Dr. Part of the problem is that in the US, a pregnant woman’s first prenatal appointment may be the first time she sees a doctor. Historically, pregnant women with risk factors for diabetes are tested for GD in the second or third trimester of pregnancy using a two-step approach: a glucose challenge test followed by an oral glucose tolerance test.3 But when a woman has never been tested for diabetes, testing for GD later in pregnancy can make it difficult to distinguish between pre-existing diabetes and GD. 2 Diabetes screening in early pregnancy aims to identify women at risk of complications so they can make healthy lifestyle changes or begin treatment with medications however, there are no set standards for early GD screening in the US. In both cases, diabetes in pregnancy is associated with maternal and fetal complications, including preeclampsia, metabolic dysfunctions, and higher rates of NICU admissions. 1 But sometimes, women can have pre-existing diabetes and not know it, in which case the challenge often becomes distinguishing between pre-existing diabetes and GD. Gestational diabetes (GD) is a common complication in pregnancy, and in the US, up to 15 percent of pregnant women develop GD.
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