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Obstetrics & Gynecology 1984;64:347-350
© 1984 by The American College of Obstetricians and Gynecologists
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Use of Glycosylated Hemoglobin as a Screen for Macrosomia in Gestational Diabetes

LAXMI BAXI, MD, DAVID BARAD, MD, E. ALBERT REECE, MD and ROBERT FARBER, MD

From the Division of Maternal-Fetal Medicine of the College of Physicians and Surgeons of Columbia University, and the Shane Hospital for Women at the Columbia-Presbyterian Medical Center, New York, New York.

Abstract

Glycosylated hemoglobin and blood sugar levels in the fasting state and two hours after oral 100 g glucose load were measured in 180 patients. Glycosylated hemoglobin was measured by cation exchange column chromatography, and blood sugar was measured by hexokinase reaction. Patients with an elevated postprandial and/or fasting blood sugar level (positive screen) subsequently underwent three-hour glucose tolerance test. The mean value of glycosylated hemoglobin in patients with a negative screen and normal hemoglobin was 6.17 ± 0.61%; and the value for glycosylated hemoglobin in patients with class A diabetes and normal hemoglobin electrophoresis was 6.85 ± 0.73% (P < .001). A glycosylated hemoglobin value greater than 6.78 (mean + 1 SD) was considered elevated. Glycosylated hemoglobin values were elevated in 21 of 33 patients with gestational diabetes and in 27 of 147 patients with normal blood sugar levels. The sensitivity and specificity of glycosylated hemoglobin for the diagnosis of gestational diabetes were 63.6 and 81.6%, respectively. Fifty percent of patients with an initially elevated glycosylated hemoglobin value delivered macrosomic infants, whereas no patient with a normal glycosylated hemoglobin value had a macrosomic infant. An elevated glycosylated hemoglobin value may alert the obstetrician of a potentially elevated mean blood sugar level and may warrant aggressive management of gestational diabetes.






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Copyright © 1984 by the American College of Obstetricians and Gynecologists.