Journal of Family and Reproductive Health 2017. 11(1):37-42.

The Best Cut-Off Value for HbA1c as a Screening Tool in Iranian Women With Gestational Diabetes Mellitus
Seyedeh Neda Mousavi, Koorosh Kamali, Motahareh Mirbazel, Maryam Jameshorani


Objective: Gestational diabetes mellitus (GDM) is a prevalent disorder which increases maternal and fetal complications. The oral glucose tolerance test (OGTT) is a traditional, time -consuming and intensive test which is poorly tolerated by pregnant women. To date, increasing evidence considered HbA1c as a screening tool and reported various cut-off values in different populations. In alignment with existing literature, we determined for the first time, the optimal cut-off value for HbA1c in Iranian women with GDM.
Materials and methods: This case-control study was conducted in Valie-Asr hospital between June 2015 and March 2016. A total of 200 pregnant women who were diagnosed with GDM were selected as study cases. For the control group, 200 healthy women were randomly selected. Fasting blood samples were taken for biochemical analysis, and OGTT was done in all participants. Demographic and anthropometric indexes were measured. Performance of the HbA1c test was analyzed by the Receiver Operating Characteristic (ROC) curve, and the sensitivity and specificity for different HbA1c cut-off points were calculated subsequently.
Results: Analysis showed that the mean age (p < 0.001) and BMI (p < 0.001) were significantly higher in the GDM group compared to those in non-GDM pregnant women. GDM participants reported positive family- and previous history of GDM more than healthy pregnant women (p = 0.04 and p < 0.001, respectively). All the markers for Lipid profile were significantly different between the two groups
(p = <0.001) except for total cholesterol. The rate of Caesarean section and neonate’s Apgar score were not significantly different between the two groups. The best equilibrium between sensitivity (80%) and specificity (76%) for HbA1c was 5.05%.
Conclusion: Our results suggest that pregnant women with HbA1c of ≥ 5.05% should proceed with an OGTT. Further investigations with larger sample size are needed to provide more robust evidence for the diagnostic and screening value of HbA1c in identifying pregnant women with GDM.


Glucose Tolerance Test; Gestational Diabetes Mellitus; Glycosylated Hemoglobin A

Full Text:



ADA. American Diabetes Association position statement: gestational diabetes mellitus. Diabetes Care 2014; 27: S88-¬S90.

Velkoska Nakova V, Krstevska B, Dimitrovski Ch, Simeonova S, Hadzi-Lega M, Serafimoski V, et al. Prevalence of thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes and diabetes type 1. Prilozi 2010; 31: 51-¬9.

Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, et al. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers for screening. Diabet Med 2012; 29: 844-¬54.

Monk C, Georgieff MK, Osterholm EA. Research review: maternal prenatal distress and poor nutrition—mutually influencing risk factors affecting infant neurocognitive development. J Child Psychol Psychiatry 2013; 54:115-30.

Nankervis A, McIntyre HD, Moses RG, P. Ross G, K. Kallaway L. Testing for gestational diabetes mellitus in Australia. Diabetes Care 2013; 36:e64.

van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update 2011; 17: 605-19.

Waugh N, Pearson D, Royle P. Screening for hyperglycaemia in pregnancy: Consensus and controversy. Best Pract Res Clin Endocrinol Metab 2010; 24:553–71.

Farrar D, Duley L, Medley N, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev 2015; 21: CD007122.

American Diabetes Association. Classification and diagnosis of Diabetes. Diabetes Care 2015; 38:s8–s16.

World Health Organization. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Abbreviated report of a WHO consultation 2011.Available: diagnosis_diabetes2011/en/index.html Accessed 5 October 2014.

d’Emden M. Glycated haemoglobin for the diagnosis of diabetes. Aust Prescriber 2014; 37: 98–100.

Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term variability in measures of glycemia and implications for the classification of diabetes. Arch Intern Med 2007; 167: 1545–51.

Agarwal MM, Hughes PF, Punnose J, Ezimokhai M, Thomas L. Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins. Diabetes Res Clin Pract 2001; 51:67–73.

Agarwal MM, Dhatt GS, Punnose J, Koster G. Gestational diabetes: a reappraisal of HBA1c as a screening test. Acta Obstet Gynecol Scand 2005; 84:1159–63.

Pollak A, Brehm R, Havelec L, Lubec G, Malamitsi-Puchner A, Simbrunner G, et al. Total glycosylated hemoglobin in mothers of large-for-gestational-age infants: a postpartum test for undetected maternal diabetes? Biol Neonate 1981; 40:129–35.

Griffiths RJ, Vinall PS, Stickland MH, Wales JK. Haemoglobin A1c levels in normal and diabetic pregnancies. Eur J Obstet Gynecol Reprod Biol 1987; 24: 195–200.

Moses RG. HbA1c and the diagnosis of gestational diabetes mellitus-a test whose time has not yet come. Diabetes Res Clin Pract 2012; 98:3-4.

Breitenbach Renz P, Cavagnolli G, Schwerz Weinert L, Pinho Silveiro S, Lins Camargo J. HbA1c Test as a Tool in the Diagnosis of Gestational Diabetes Mellitus. PLOS ONE 2015; 10:e0135989.

Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, et al. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ Open 2016; 6: e011059.

Rajput R, Yogesh Yadav, Rajput M, Nanda S. Utility of HbA1c for diagnosis of gestational diabetes mellitus. Diabetes Res Clin Pract 2012; 98:104–7.

A. Aldasouqi S, J. Solomon D, A. Bokhari S, M. Khan P, Muneera Sh, V. Gossain V. Glycohemoglobin A1c: a promising screening tool in gestational diabetes mellitus. Int J Diabetes Dev Ctries 2008; 28:121–4.

Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr 2000; 71:1256S-61S.

Lippi G, Targher G. Glycated hemoglobin (HbA1c): old dogmas, a new perspective? Clin Chem Lab Med 2010;48:609–14.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.