Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017

Abstract

Glycated hemoglobin is an adjunct tool in early pregnancy to assess glycemic control. We examined trends and maternal predictors for those who had A1c screening in early pregnancy using hospital discharge and vital registry data between 2009 and 2017 linked with the New York City A1C Registry (N = 798,312). First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017. The likelihood of screening became less targeted to high-risk patients over time, with a decrease in mean A1c values from 5.8% (95% confidence interval [CI]: 5.8, 5.9) to 5.3 (95% CI: 5.3, 5.4). The prevalence of gestational diabetes mellitus increased while testing became less discriminate for those with high-risk factors, including pregestational type 2 diabetes, chronic hypertension, obesity, age over 40 years, as well as Asian or Black non-Hispanic race/ethnicity.

Key Points

• First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017 in New York City.

• The likelihood of screening became less targeted to high-risk patients over time.

• The prevalence of gestational diabetes mellitus increased, while testing became less discriminate.

Keywords

first-trimester hemoglobin A1c screening - pregestational diabetes - A1c screening - hemoglobin A1c

Precis

First-trimester hemoglobin A1C screening has increased from 2009 to 2017, while testing became less discriminate for those with high-risk factors in pregnancy.

Publication History

Received: 02 January 2023

Accepted: 17 August 2023

Accepted Manuscript online:
21 August 2023

Article published online:
29 September 2023

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