1038 J. Endocrinol. Invest. 36: 1038-1045, 2013 DOI: 10.3275/9037 ABSTRACT. Background/Aims: The use of glycated hemoglobin (HbA1c) measurement in gestational diabetes mellitus (GDM) is controversial. Aim of the present study was to determine HbA1c levels in a series of GDM patients, in order to verify the possible contribution of HbA1c to GDM management. Materials/Subjects and methods: The study included 148 cau- casian GDM patients. GDM screening was performed be- tween the 24 th and the 28 th week of gestation by a two-step procedure, according to the 4 th and 5 th International Work- shop Conference on Gestational Diabetes Mellitus recom- mendations. Exclusion criteria were: preexisting diabetes, corticosteroid therapy, history of asthma or hypertension, known fetal anomaly, history of previous stillbirth, preterm delivery considered to be likely for either maternal disease or fetal conditions. HBA1c was determined by a standard HPLC technique. Results: At GDM diagnosis, all HbA1c levels were ≤6% and the greatest frequency (71/148; 48.0%) of HbA1c values resulted in the range 5.0-5.3%. This frequency in- creased to 54% before delivery. A significant correlation be- tween HbA1c values at GDM diagnosis and individual BMI prior to conception was observed. The proportion of preg- nancies presenting negative outcomes increased progres- sively with increasing HbA1c levels, from 6.2% (1/16) for HbA1c levels <5% to 18.3% (13/71) for HbA1c 5.0-5.3%, to 37.8% (17/45) in patients with HBA1c levels 5.4-5.6%, to 56.2% (9/16) for HbA1c levels >5.6%. ROC analysis showed that HbA1c at diagnosis and before delivery resulted a good predictor of adverse pregnancy outcome. Conclusions: The present results indicate that HbA1c levels could be of help in predicting adverse pregnancy events. (J. Endocrinol. Invest. 36: 1038-1045, 2013) © 2013, Editrice Kurtis INTRODUCTION Glucose intolerance of any severity identified during pregnancy is defined gestational diabetes mellitus (GDM). This condition could preexist in unrecognized form or begin concomitantly with pregnancy and, in some cases, persist after delivery (1). Since several adverse outcomes have been associated to hyperglycemia during pregnancy (2), many efforts have been made to define the optimal criteria for GDM diag- nosis and management. Nevertheless, the indications provided by the different scientific organizations are not univocal (3, 4). For more than a decade, GDM screening was performed using a two-step protocol (1, 5) based on initial 50-gr Glu- cose Challenge Test (GCT) and subsequent confirmative traditional Oral Glucose Tolerance Test (OGTT). In 2008, the HAPO Study demonstrated the detrimental effect of hyperglycemia occurring even at venous blood glucose (BG) values below those considered diagnostic for GDM, based on the 2007 standards (6), and in 2010 the Inter- national Association of Diabetes and Pregnancy Study Groups (IADPSG) established more stringent parameters for GDM diagnosis (7). In January 2011, the American Di- abetes Association endorsed this recommendation (8). Shortly after, however, the American College of Obstet- rics and Gynecology stood against the latest IADPSG po- sition (9). Thus, the optimal approach to GDM screening and management is still a matter of debate. The advantages of the hemoglobin A1C (HbA1c) in dia- betic patient management have been widely recognized for many years (10, 11). Moreover, its use to diagnose di- abetes was recently accepted by the most influent sci- entific organizations (8, 12). During pregnancy, HbA1c determination is routinely used in women with preexist- ing Type 1 or Type 2 diabetes (T1D, T2D) (13, 14). In- deed, it is recommended to employ exclusively BG cri- teria for GDM diagnosis (8) and the use of HbA1c deter- mination in such patients is still controversial (15-17). The aim of the present study was to verify whether HbA1c measurement in pregnant women with GDM could con- tribute to the identification of the patients at higher risk for adverse outcomes. SUBJECTS AND METHODS Screening for GDM One thousand, one hundred and fifty pregnant women evalu- ated between the 8 th and the 10 th gestational week at the Ob- stetrics Department of the “Pugliese-Ciaccio” Hospital, Catan- zaro, Italy from January 1 st , 2009 to March 31 st , 2010, were ad- dressed to the outpatient clinics of Endocrinology and Diabetes Unit for the presence of at least one risk factor for gestational di- abetes. The gestational age was estimated on the basis of the re- ported date of the last menstrual period. All women were interviewed on family history of T2D, previous GDM, systemic or organ diseases, previous or present pharma- *These authors equally contributed to the study and both may claim last authorship. Key-words: A1C, body mass index, gestational diabetes, maternal outcomes, fetal outcomes. Correspondence: C. Capula, Dipartimento di Scienze della Salute, Università “Magna Græcia” di Catanzaro, Viale Europa, località Germaneto, 88810 Catanzaro, Italy. E-mail: carmelo.capula@yahoo.it Accepted June 26, 2013. First published online July 15, 2013. HbA1c levels in patients with gestational diabetesmellitus: Relationship with pre-pregnancy BMI and pregnancy outcome C. Capula 1,2 , T. Mazza 3 , R. Vero 1 *, and G. Costante 2 * 1 Struttura Operativa Complessa Endocrinologia-Diabetologia, Azienda Ospedaliera “Pugliese-Ciaccio”, Catanzaro, 2 Dipartimento di Scienze della Salute, Università “Magna Græcia”, Catanzaro, 3 IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy © 2013, Editrice Kurtis FOR PERSONAL USE ONLY