COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy?

International audienceAims: To evaluate proposals considering HbA1c and fasting plasma glucose (FPG) measure-ment as a substitute for oral glucose tolerance test (OGTT) to diagnose hyperglycaemia in pregnancy (HIP) during COVID-19 pandemic. Methods: Of the 7,334 women who underwent the OGTT between 22 and 30 weeks gesta-tion, 966 had HIP (WHO diagnostic criteria, reference standard). The 467 women who had an available HbA1c were used for analysis. French-speaking Society of Diabetes (SFD) pro-posal to diagnose HIP during COVID-19 pandemic was retrospectively applied: HbA1c >5.7% (39 mmol/mol) and/or FPG level >5.1 mmol/l. SFD proposal sensitivity for HIP diagnosis and the occurrence of HIP-related events (preeclampsia, large for gestational age infant, shoul-der dystocia or neonatal hypoglycaemia) in women with false negative (FN) and true pos-itive (TP) HIP-diagnoses were evaluated. Results: The sensitivity was 57% [95% confidence interval 52-62]. FN women had globally lower plasma glucose levels during OGTT, lower HbA1c and body mass index than those TP. The percentage of HIP-related events was similar in FN (who were cared) and TP cases, respectively 19.5 and 16.9% (p = 0.48). We observed similar results when women at high risk for HIP only were considered. Conclusion: The SFD proposal has a poor sensitivity to detect HIP. Furthermore, it fails to have any advantages in predicting adverse outcomes