Screening for Undiagnosed Diabetes in the First Trimester of Pregnancy: A Summary of the Evidence.
PHE ePoster Library. Beynon C. Sep 12, 2017; 186541; 79
Mrs. Claire Beynon
Mrs. Claire Beynon
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Abstract
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Abstract BackgroundDiabetes in pregnancy is associated with miscarriage, stillbirth, congenital abnormalities, macrosomia and perinatal mortality. The demographics of the population becoming pregnant has changed (more obese and older women). More women are therefore entering pregnancy with undiagnosed diabetes. Routine measurement of HbA1c is not undertaken as part of the first trimester blood tests in the UK. The National Clinical Lead for Diabetes requested that due to growing evidence and its recent introduction in New Zealand this be reviewed. AimTo review the literature on HbA1c as a screening tool to identify undiagnosed diabetes in the first trimester of pregnancy. MethodsA systematic search of the evidence was undertaken using specific search criteria from Cochrane Library, EMBASE, Medline, NICE Guidance, PROSPERO and PubMed. The initial search identified 319 papers, based on the inclusion and exclusion criteria eight papers were critically appraised. ResultsThere is limited evidence on the use of HbA1c as a screening tool for undiagnosed diabetes in the literature during the first trimester of pregnancy. Most research assesses HbA1c as an indicator for gestational diabetes in the third trimester. Although HbA1c is considered a useful test for diabetes in the non pregnant population the hormonal and metabolic changes that occur in pregnancy mean that there are many limitations in pregnancy. Furthermore, HbA1c levels are affected by iron deficiency which is common in pregnancy. Conclusions and RecommendationsThere is insufficient evidence to suggest a change in practice to include offering HbA1c screening for undiagnosed diabetes in the first trimester.
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