title: Is There a Role for HbA1c in Pregnancy?
abstract: Outside pregnancy, HbA1c analysis is used for monitoring, screening for and diagnosing diabetes and prediabetes. During pregnancy, the role for HbA1c analysis is not yet established. Physiological changes lower HbA1c levels, and pregnancy-specific reference ranges may need to be recognised. Other factors that influence HbA1c are also important to consider, particularly since emerging data suggest that, in early pregnancy, HbA1c elevations close to the reference range may both identify women with underlying hyperglycaemia and be associated with adverse pregnancy outcomes. In later pregnancy, HbA1c analysis is less useful than an oral glucose tolerance test (OGTT) at detecting gestational diabetes. Postpartum, HbA1c analysis detects fewer women with abnormal glucose tolerance than an OGTT, but the ease of testing may improve follow-up rates and combining HbA1c analysis with fasting plasma glucose or waist circumference may improve detection rates. This article discusses the relevance of HbA1c testing at different stages of pregnancy.
authors.affiliation: Department of Obstetrics and Gynaecology, Christchurch Women's Hospital, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand. ruth.hughes@cdhb.health.nz.
authors.forename: Ruth C E
authors.initials: RC
authors.lastname: Hughes
authors.affiliation: National Women's Hospital, Auckland City Hospital, Private Bag 92-024, Grafton, Auckland, New Zealand. janetrowan1@gmail.com.
authors.forename: Janet
authors.initials: J
authors.lastname: Rowan
authors.affiliation: Canterbury Health Laboratories, PO Box 151, Christchurch, 8140, New Zealand. Chris.Florkowski@cdhb.health.nz.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Florkowski
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes; Gestational diabetes; HbA1c; Postpartum; Prediabetes; Pregnancy; Screening