PMID- 37289757
OWN - NLM
STAT- MEDLINE
DCOM- 20230612
LR  - 20231118
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 18
IP  - 6
DP  - 2023
TI  - Early postpartum HbA1c after hyperglycemia first detected in pregnancy-Imperfect 
      but not without value.
PG  - e0282446
LID - 10.1371/journal.pone.0282446 [doi]
LID - e0282446
AB  - BACKGROUND: South African women of childbearing age are disproportionally 
      affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). 
      Unless pregnant, they do not readily undergo screening for T2DM. With a local 
      focus on improved antenatal care, hyperglycemia is often first detected in 
      pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes 
      Mellitus (GDM) in all without considering T2DM. Glucose evaluation following 
      pregnancy is essential for early detection and management of women with T2DM in 
      whom persistent hyperglycemia is to be expected. Conventional testing with an 
      oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for 
      alternate solutions. AIM: To compare the diagnostic performance of HbA1c to the 
      current gold standard OGTT in women with HFDP 4-12 weeks post-delivery. METHODS: 
      Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4-12 
      weeks after delivery. Glucose status was based on American Diabetes Association 
      criteria. RESULTS: Glucose homeostasis was assessed at 10 weeks (IQR 7-12) after 
      delivery. Of the 167 participants, 52 (31%) had hyperglycemia, which was 
      comprised of 34 (20%) prediabetes and 18 (11%) T2DM. Twelve women in the 
      prediabetes subgroup had diagnostic fasting plasma glucose (FPG) and 2-hour 
      plasma glucose (2hPG), but in two-thirds of the patients (22/34) only one time 
      point proved diagnostic. The FPGs and the 2hPGs of six women with HbA1c-based 
      T2DM were both within the prediabetes diagnostic range. According to the HbA1c 
      measurements, 85% of 52 participants with gold standard OGTT defined 
      hyperglycemia (prediabetes and T2DM) as well as 15 of 18 women with postpartum 
      persistent T2DM were correctly classified. According to FPG, 15 women with 
      persistent hyperglycemia would have been missed (11 with prediabetes and four 
      with T2DM; 29%). When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) 
      postpartum demonstrated a sensitivity of 83% and specificity of 97% for the 
      identification of T2DM. CONCLUSION: HbA1c may improve access to postpartum 
      testing in overburdened clinical settings where the required standards of OGTT 
      cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit 
      most from early intervention but cannot unequivocally replace OGTT.
CI  - Copyright: (c) 2023 Coetzee et al. This is an open access article distributed under 
      the terms of the Creative Commons Attribution License, which permits unrestricted 
      use, distribution, and reproduction in any medium, provided the original author 
      and source are credited.
FAU - Coetzee, Ankia
AU  - Coetzee A
AUID- ORCID: 0000-0001-9993-6439
AD  - Department of Medicine, Division of Endocrinology Stellenbosch University and 
      Tygerberg Hospital, Cape Town, South Africa.
FAU - Hall, David R
AU  - Hall DR
AUID- ORCID: 0000-0002-2344-3969
AD  - Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg 
      Hospital, Cape Town, South Africa.
FAU - van de Vyver, Mari
AU  - van de Vyver M
AD  - Department of Medicine, Division of Clinical Pharmacology, Stellenbosch 
      University and Tygerberg Hospital, Cape Town, South Africa.
FAU - Conradie, Magda
AU  - Conradie M
AUID- ORCID: 0000-0003-3092-4098
AD  - Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg 
      Hospital, Cape Town, South Africa.
LA  - eng
PT  - Journal Article
DEP - 20230608
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin)
RN  - IY9XDZ35W2 (Glucose)
SB  - IM
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - *Diabetes Mellitus, Type 2/complications/diagnosis
MH  - *Prediabetic State
MH  - Blood Glucose
MH  - Glycated Hemoglobin
MH  - *Hyperglycemia/diagnosis
MH  - *Diabetes, Gestational/diagnosis
MH  - Postpartum Period
MH  - Glucose
PMC - PMC10249808
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/06/08 19:14
MHDA- 2023/06/12 06:42
PMCR- 2023/06/08
CRDT- 2023/06/08 13:43
PHST- 2023/02/14 00:00 [received]
PHST- 2023/05/11 00:00 [accepted]
PHST- 2023/06/12 06:42 [medline]
PHST- 2023/06/08 19:14 [pubmed]
PHST- 2023/06/08 13:43 [entrez]
PHST- 2023/06/08 00:00 [pmc-release]
AID - PONE-D-23-03908 [pii]
AID - 10.1371/journal.pone.0282446 [doi]
PST - epublish
SO  - PLoS One. 2023 Jun 8;18(6):e0282446. doi: 10.1371/journal.pone.0282446. 
      eCollection 2023.