Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population-based retrospective cohort study

Translated title of the contribution: Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population-based retrospective cohort study

Enav Yefet, Elad Jeda, Ayellet Tzur, Zohar Nachum

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: To examine possible markers for undiagnosed type 2 diabetes in early-onset gestational diabetes mellitus (GDM). Methods: A population-based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50-g glucose challenge test, 100-g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression. Results: Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%-100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2-109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value. Conclusions: Early-onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery.

Translated title of the contributionMarkers for undiagnosed type 2 diabetes mellitus during pregnancy—A population-based retrospective cohort study
Original languageEnglish
Pages (from-to)205-214
Number of pages10
JournalJournal of Diabetes
Volume12
Issue number3
DOIs
StatePublished - 1 Mar 2020

Bibliographical note

Publisher Copyright:
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd

Keywords

  • HbA1c
  • diabetes mellitus
  • gestational diabetes mellitus
  • pregnancy
  • type 2 diabetes

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