Positivity thresholds of HbA1c assay as a screening test for diabetes mellitus in the first trimester in high-risk populations

The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Allison R Walker, Aaron B Caughey

Abstract

Objective: Both gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) are associated with increased risks of preeclampsia, macrosomia, shoulder dystocia, and irreversible brachial plexus injury (BPI). Compared to the conventional second trimester oral glucose tolerance test (OGTT), screening with the HbA1c assay in the first trimester with a diagnostic second trimester OGTT has been shown to diagnose more cases of T2DM and GDM earlier. Our study examined the effect of treatment based on varied positivity thresholds in high-risk pregnancies.Study design: A decision analysis model was created using TreeAge 2016 software to compare the outcomes of screening with an HbA1C in the first trimester verses no first trimester screening, with positivity thresholds ranging from 5.9 to 6.4%. Outcomes examined included neonatal mortality, preeclampsia, preterm delivery, cerebral palsy, macrosomia, permanent BPI, cost, and quality adjusted life years (QALYs) of the mother and neonate. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Univariate analyses were used to investigate the impact of screening positivity.Results: First trimester screenin...Continue Reading

References

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