Assessment of risk factors and glycosylated haemoglobin in early pregnancy as predictors of diabetes in pregnancy

Background: The aim of the study was to determine the performance of history of risk factors and universal HBA1c testing as screening tools for diabetes mellitus in the first trimester of pregnancy using OGTT as a gold standard.Methods: A prospective cross-sectional study conducted between 8 and 13±6 weeks in 305 consecutive pregnancies in the antenatal clinics of the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH) between January and August 2020. Each woman had oral glucose tolerance test (OGTT), and glycosylated haemoglobin (HBA1c) levels estimation. Multivariate logistic regression analysis was carried out with history of risk factors and HBA1c level as independent variables and OGTT as the dependent variable for the assessment of their predictive performances.Results: The prevalence of DM was 28.85%, 2.62% and 31.48% for GDM, pre-gestational and for both respectively. Family history of DM was associated with high specificity (91.4%) and negative predictive value (NPV) of 68.7% but low sensitivity (9.4%) and positive predictive value (PPV) (33.3%). The receiver operator characteristic curve for HBA1c revealed a significant area under the curve value: 0.653 (CI: 058-0.72), p<0.01. The optimal cut-off for HBA1c from Youden index was 5.25%. HBA1c levels had high specificity (88.5%) and NPV (75.2%) with low sensitivity (36.5%) and PPV (59.3%). Multivariate logistic regression analysis showed HbA1c as the only independent predictor of GDM (p=0.0001).Conclusions: The high prevalence of diabetes (31.48%), underscores the need for universal screening in early pregnancy. The high NPV and specificity of the risk factors for GDM and HBA1c levels better predict pregnancies that are not likely to develop GDM, but they are not suitable for diagnosis because of the low sensitivity and PPV.

Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia

Background: Preeclampsia is a multisystem disorder causing vascular endothelial damage and leads to leakage of lactate dehydrogenase (LDH) into maternal serum. This study evaluated the serum LDH levels in severe preeclamptic women to detect any correlation with adverse pregnancy outcomes.Methods: A prospective cohort study compared LDH levels of 68 severe preeclamptic women with 68 normotensives in the third trimester, matched for age, parity, and gestational age. The preeclamptic women were followed up until delivery to assess the maternal and neonatal outcomes. Data were analyzed with SPSS for Windows version 23. The level of significance was set at p<0.05.Results: Both groups were comparable in their characteristics. The mean LDH level for severe preeclamptic group (717.40 IU/L) was higher than for the normotensive group (162.90 IU/L) and this was significant (p=0.001). Cesarean delivery was less likely when LDH was >600 compared to ?600 (OR 0.31; p=0.049) indicating a potential protective effect. The likelihood of IUGR (OR 3.14; p=0.045), IUFD (OR 6.48; p=0.028), stillbirth (OR 7.06 p=0.007), perinatal mortality (OR 4.84; p=0.004) and low birth weight <2500 gm (OR 3.77; p=0.025) were all significantly higher with LDH levels >600 IU/L.Conclusions: Maternal serum LDH levels were found to be significantly increased in pregnant women with severe preeclampsia compared to their normotensive counterparts, and elevated levels >600 IU/L in the third trimester was associated with adverse perinatal outcomes.