Universal HbA1c Measurement in Early Pregnancy to Detect Type 2 Diabetes Reduces Ethnic Disparities in Antenatal Diabetes Screening: A Population-Based Observational Study
Open accessAbstract
In response to the type 2 diabetes epidemic, measuring HbA1c with the first-antenatal blood screen was recently recommended in NZ. This would enable prompt treatment of women with unrecognised type 2 diabetes, who may otherwise go undetected until the gestational diabetes (GDM) screen. We compare inter-ethnic antenatal screening practices to examine whether the HbA1c test would be accessed by ethnicities most at risk of diabetes, and we determined the prevalence of unrecognised type 2 diabetes and prediabetes in our pregnant population. This is an observational study of pregnancies in Christchurch NZ during 2008-2010. Utilising electronic databases, we matched maternal characteristics to first-antenatal bloods, HbA1c, and GDM screens (glucose challenge tests and oral glucose tolerance tests). Overall uptake of the first-antenatal bloods versus GDM screening was 83.1% and 53.8% respectively in 11,580 pregnancies. GDM screening was lowest in Māori 39.3%, incidence proportion ratio (IPR) 0.77 (0.71, 0.84) compared with Europeans. By including HbA1c with the first-antenatal bloods, the number screened for diabetes increases by 28.5% in Europeans, 40.0% in Māori, 28.1% in Pacific People, and 26.7% in 'Others' (majority of Asian descent). The combined prevalence of unrecognised type 2 diabetes and prediabetes by NZ criteria, HbA1c ≥5.9% (41mmol/mol), was 2.1% in Europeans, Māori 4.7% IPR 2.59 (1.71, 3.93), Pacific People 9.5% IPR 4.76 (3.10, 7.30), and 'Others' 6.2% IPR 2.99 (2.19, 4.07). Applying these prevalence data to 2013 NZ national births data, routine antenatal HbA1c testing could have identified type 2 diabetes in 0.44% and prediabetes in 3.96% of women. Routine HbA1c measurement in early pregnancy is an ideal screening opportunity, particularly benefitting vulnerable groups, reducing ethnic disparities in antenatal diabetes screening. This approach is likely to have world-wide relevance and applicability. Further research is underway to establish whether, as for type 2 diabetes, prompt treatment of prediabetes improves pregnancy and neonatal outcomes.
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Evidence from Aotearoa New Zealand suggests that routine HbA1c measurement reduces disparities in screening.
“Evidence from Aotearoa New Zealand suggests that routine HbA1c measurement reduces disparities in screening. 55”
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- Authors
- Hughes, R. C. E., Williman, J., & Gullam, J. E.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- Hughes, R. C. E.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-06-07
- Volume
- 11
- Issue
- 6
- Pages
- e0156926
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4896429
- OpenAlex
- W2410220824
- Cited by
- 19
- References
- 12
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 1
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- HbA1c, type 2 diabetes in pregnancy, gestational diabetes mellitus, prediabetes, ethnic disparities, Māori, Pacific Islanders, screening uptake, oral glucose tolerance test, glucose challenge test
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Mass Screening, New Zealand, Pregnancy, Prenatal Diagnosis, Retrospective Studies, Sensitivity and Specificity, Prevalence, Diabetes, Gestational, Early Diagnosis, Young Adult
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