Early Gestational Diabetes Mellitus Screening With Glycated Hemoglobin: A Systematic Review
Abstract
Objective This review sought to examine the association of HbA 1c levels Methods A search of Medline and EMBASE was conducted for the period of January 1, 2000 to July 9, 2019 and the terms: "gestational diabetes or pregnancy diabetes mellitus" and "glycosylated hemoglobin or glycated hemoglobin A" and "pregnancy trimester, first, or first-trimester pregnancy," "screening or prenatal screening," "prenatal diagnosis or early diagnosis or prediction," "retrospective studies or prospective studies." Quality of evidence was assessed using the Newcastle-Ottawa scale. Inclusion criteria were: measurement of HbA 1c 1c levels below 6.5%. The primary outcome evaluated was the development of GDM. Secondary outcomes were adverse pregnancy outcomes, including large-for-gestational-age birth weight, macrosomia, preterm birth, neonatal and perinatal death, congenital anomaly, preeclampsia, shoulder dystocia, and cesarean section. Results We screened 121 relevant abstracts. Thirty-two studies qualified for a full review, of which 11 met the eligibility criteria. All studies were assessed as high quality and found an increased risk of GDM with HbA 1c levels >5.7. Levels >6.0 identified all patients who developed GDM. Adverse pregnancy outcomes were associated with elevated HbA 1c levels in 4 of 6 studies and included preeclampsia, induced labour, shoulder dystocia, cesarean section, large-for-gestational-age birth weight, macrosomia, congenital anomalies, and perinatal death. Two studies fou…
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Early abnormal glucose metabolism, defined as a fasting glucose threshold of 110 mg/dL or an A1C of 5.9%, may identify individuals at higher risk of adverse pregnancy and neonatal outcomes, more likely to need insulin treatment, and at high risk of a later GDM diagnosis.
“Early abnormal glucose metabolism, defi ned as a fasting glucose threshold of 110 mg/dL (6.1 mmol/L) or an A1C of 5.9% (41 mmol/mol), may identify individuals who are at higher risk of adverse pregnancy and neonatal outcomes (preeclampsia, macrosomia, shoulder dystocia, and perinatal death), are more likely to need insulin treatment, and are at high risk of a later GDM diagnosis (189 -194).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [194]
Early abnormal glucose metabolism, defined as a fasting glucose threshold of 110 mg/dL or an A1C of 5.9%, may identify individuals who are at higher risk of adverse pregnancy and neonatal outcomes (preeclampsia, macrosomia, shoulder dystocia, and perinatal death), are at high risk of a later GDM diagnosis, and are more likely to need insulin treatment.
“Early abnormal glucose metabolism, defined as a fasting glucose threshold of 110 mg/dL (6.1 mmol/L) or an A1C of 5.9% (41 mmol/mol), may identify individuals who are at higher risk of adverse pregnancy and neonatal outcomes (preeclampsia, macrosomia, shoulder dystocia, and perinatal death), are at high risk of a later GDM diagnosis, and are more likely to need insulin treatment (174-176).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [176]
First-trimester glycated hemoglobin assessment is an additional prognostic marker and should not be analyzed separately.
“The first-trimester glycated hemoglobin (HbA1c) assessment is pointed out to be an additional prognostic marker and should not be analyzed separately.”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [11]
First-trimester glycated hemoglobin has insufficient sensitivity and specificity and may not detect the whole population of patients.
“Its insufficient sensitivity and specificity may not detect the whole population of patients [10,11].”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [11]
Cites
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RETIRED: Diabetes in Pregnancy
Berger, H., Gagnon, R., & Sermer, M. (2016) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2016.04.002 · Cited by 108 · see citing works
Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus
Fong, A., Serra, A. E., Gabby, L., Wing, D. A., & Berkowitz, K. M. (2014) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2014.06.016 · Cited by 94 · see citing works
Role of first trimester HbA1c as a predictor of adverse obstetric outcomes in a multi-ethnic cohort.
Mañé, L., Flores-Le Roux, J. A., Benaiges, D., Rodríguez, M., Marcelo, I., Chillarón, J. J., Pedro-Botet, J., Llauradó, G., Gortazar, L., Carreras, R., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2581 · Cited by 91 · see citing works
HbA1c Measured in the First Trimester of Pregnancy and the Association with Gestational Diabetes
Hinkle, S. N., Tsai, M. Y., Rawal, S., Albert, P. S., & Zhang, C. (2018) · Scientific Reports · doi:10.1038/s41598-018-30833-8 · Cited by 57 · see citing works
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2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s002 · Cited by 4,792 · see citing works
2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s002 · Cited by 3,116 · see citing works
2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Gaglia, J. L., Hilliard, M. E., Johnson, E. L., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s002 · Cited by 2,086 · see citing works
2. Diagnosis and classification of diabetes: standards of care in diabetes-2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Ebekozien, O., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s002 · Cited by 1,393 · see citing works
Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors
Yang, Y., & Wu, N. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.831297 · Cited by 155 · see citing works
Evolution of Gestational Diabetes Mellitus across Continents in 21st Century
Dłuski, D. F., Ruszała, M., Rudziński, G., Pożarowska, K., Brzuszkiewicz, K., & Leszczyńska-Gorzelak, B. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192315804 · Cited by 41 · see citing works
- Authors
- Kattini, R., Hummelen, R., & Kelly, L.
- Affiliations
- NOSM University (CA)
- Sioux Lookout First Nations Health Authority (CA)
- Corresponding author
- Kelly, Len
- ORCID
- Kelly, Len
- Venue
- Journal of Obstetrics and Gynaecology Canada
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 42
- Issue
- 11
- Pages
- 1379-1384
- ISSN
- 1701-2163 (ISSN-L)
- OpenAlex
- W3015610276
- Cited by
- 60
- References
- 6
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 11 · 2023: 11 · 2022: 10 · 2021: 11 · 2020: 2
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Obstetrics and Gynaecology Canada (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- gestational diabetes mellitus, HbA1c, early pregnancy screening, HbA1c thresholds, adverse pregnancy outcomes, macrosomia, preeclampsia, shoulder dystocia, cesarean section, perinatal death, congenital malformations
- MeSH terms
- Female, Glycated Hemoglobin, Humans, Pregnancy, Pregnancy Outcome, Diabetes, Gestational, Premature Birth
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