Hemoglobin A1c Versus Oral Glucose Tolerance Test in Postpartum Diabetes Screening

  1. Francisco J. Tinahones, MD, PHD1,3
  1. 1Departament of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
  2. 2Research Laboratory, IMABIS Foundation, Virgen de la Victoria University Hospital, Malaga, Spain
  3. 3Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
  4. 4Department of Internal Medicine, Carlos Haya Regional University Hospital, Malaga, Spain
  1. Corresponding author: María José Picón, mjpiconcesar{at}, or Mora Murri, moramurri{at}
  1. M.J.P. and M.M. contributed equally to this study.


OBJECTIVE To determine the usefulness of measuring hemoglobin A1c (A1C), alone or combined with the fasting glucose test, compared with the oral glucose tolerance test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS We evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and A1C tests in 231 postpartum women with prior GDM 1 year after delivery.

RESULTS The prevalence of abnormal carbohydrate metabolism was 45.89% by the OGTT criterion, 19.05% by the A1C test criterion, 38.10% by the fasting glucose test criterion, and 46.75% by the A1C-fasting glucose test criteria. Using the OGTT as the gold standard, abnormal carbohydrate metabolism according to the A1C test criterion had 22.64% sensitivity and 54.55% positive predictive value; abnormal carbohydrate metabolism by the fasting glucose criterion had 83.02% sensitivity and 100% positive predictive value. The A1C-fasting glucose test criteria classified 18 women with normal carbohydrate metabolism as having abnormal carbohydrate metabolism. Abnormal carbohydrate metabolism by the A1C-fasting glucose test criteria had 83.02% sensitivity and 81.48% positive predictive value.

CONCLUSIONS Our results seem to indicate that the A1C test criterion alone or in combination with fasting glucose test criterion does not provide a sensitive and specific diagnosis of abnormal carbohydrate metabolism in women who have had GDM.

  • Received October 28, 2011.
  • Accepted March 19, 2012.

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