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The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies

Amaefule, CE; Sasitharan, A; Kalra, P; Iliodromoti, S; Huda, MSB; Rogozinska, E; Zamora, J; (2020) The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies. Current Opinion in Obstetrics and Gynecology , 32 (5) pp. 322-334. 10.1097/GCO.0000000000000648. Green open access

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Abstract

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.

Type: Article
Title: The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/GCO.0000000000000648
Publisher version: https://doi.org/10.1097/GCO.0000000000000648
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: Case-Control Studies, Diabetes, Gestational, Female, Glycated Hemoglobin A, Humans, Predictive Value of Tests, Pregnancy, Risk Factors
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10114905
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