TY - JOUR
T1 - The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes
T2 - a systematic review and meta-analysis of test accuracy studies
AU - Amaefule, Chiamaka Esther
AU - Sasitharan, Archana
AU - Kalra, Princee
AU - Iliodromoti, Stamatina
AU - Huda, Mohammed S B
AU - Rogozinska, Ewelina
AU - Zamora, Javier
AU - Thangaratinam, Shakila
PY - 2020/10/1
Y1 - 2020/10/1
N2 - PURPOSE OF REVIEW: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy complications. Accurate screening and diagnosis of gestational diabetes are critical to treatment, and in a pandemic scenario like coronavirus disease 2019 needing a simple test that minimises prolonged hospital stay. We undertook a meta-analysis on the screening and diagnostic accuracy of the haemoglobin A1c (HbA1c) test in women with and without risk factors for gestational diabetes.RECENT FINDINGS: Unlike the oral glucose tolerance test, the HbA1c test is simple, quick and more acceptable. There is a growing body of evidence on the accuracy of HbA1c as a screening and diagnostic test for GDM. We searched Medline, Embase and Cochrane Library and selected relevant studies. Accuracy data for different thresholds within the final 23 included studies (16 921 women) were pooled using a multiple thresholds model. Summary accuracy indices were estimated by selecting an optimal threshold that optimises either sensitivity or specificity according to different scenarios.SUMMARY: HbA1c is more useful as a specific test at a cut-off of 5.7% (39 mmol/mol) with a false positive rate of 10%, but should be supplemented by a more sensitive test to detect women with GDM.
AB - PURPOSE OF REVIEW: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy complications. Accurate screening and diagnosis of gestational diabetes are critical to treatment, and in a pandemic scenario like coronavirus disease 2019 needing a simple test that minimises prolonged hospital stay. We undertook a meta-analysis on the screening and diagnostic accuracy of the haemoglobin A1c (HbA1c) test in women with and without risk factors for gestational diabetes.RECENT FINDINGS: Unlike the oral glucose tolerance test, the HbA1c test is simple, quick and more acceptable. There is a growing body of evidence on the accuracy of HbA1c as a screening and diagnostic test for GDM. We searched Medline, Embase and Cochrane Library and selected relevant studies. Accuracy data for different thresholds within the final 23 included studies (16 921 women) were pooled using a multiple thresholds model. Summary accuracy indices were estimated by selecting an optimal threshold that optimises either sensitivity or specificity according to different scenarios.SUMMARY: HbA1c is more useful as a specific test at a cut-off of 5.7% (39 mmol/mol) with a false positive rate of 10%, but should be supplemented by a more sensitive test to detect women with GDM.
KW - Case-Control Studies
KW - Diabetes, Gestational/diagnosis
KW - Female
KW - Glycated Hemoglobin A/analysis
KW - Humans
KW - Predictive Value of Tests
KW - Pregnancy
KW - Risk Factors
U2 - 10.1097/GCO.0000000000000648
DO - 10.1097/GCO.0000000000000648
M3 - Article
C2 - 32618746
SN - 1040-872X
VL - 32
SP - 322
EP - 334
JO - Current Opinion in Obstetrics and Gynaecology
JF - Current Opinion in Obstetrics and Gynaecology
IS - 5
ER -
