Photo Credit: Jovanmandic
Point-of-care A1C testing for pregnant patients with diabetes improved patients’ access to timely care.
Testing patients who are pregnant for A1C during clinic visits enables physicians to perform immediate risk assessments and act quickly if needed, according to results of a single-site study published in Laboratory Medicine.
“A1C POCT [point-of-care testing] in pregnant patients is associated with rapid decision-making by medical providers, which increased the frequency of counseling, particularly in patients with previously established [diabetes] diagnosis and nutrition referral,” wrote coauthors Homayemem Weli, MD, PhD, and Christopher W. Farnsworth, PhD.
“Quick decision-making is particularly important to address the needs of certain underserved populations,” Dr. Weli adds.
POCT has also been linked with higher costs, increased laboratory error, and reduced accuracy compared to in-laboratory testing.
A1C POCT Recommended for Patients With Diabetes
In pregnant patients with diabetes, A1C 6.0% or higher is linked with a greater risk for adverse outcomes. Therefore, the American Diabetes Association recommends A1C testing as a secondary measure of glycemic control in pregnant patients.
The researchers performed a retrospective analysis to determine the usefulness of A1C POCT in facilitating rapid counseling and diabetes care during pregnancy, especially in patients with relatively low income or those who are transient. Patients received treatment at an outpatient obstetrics office with routine, in-laboratory A1C testing before (n=70) and after (n=75) the implementation of POCT for A1C. Researchers analyzed demographics, results, physician referrals to nutritionists, counseling, and outcomes from EMRs.
Patients in the study ranged in age from 25 to 34 years; 74.3% in the in-lab testing group and 82.7% in the POCT group were African American.
Overall, 9% of the in-laboratory group and 23% of the POCT group were referred for nutrition services (P=0.02). Of these, 22% in the in-laboratory group and 42% in the POCT group received immediate counseling (P<0.01).
Although researchers inversely linked A1C level with gestational weeks at delivery (Pearson r −0.39 for the in-laboratory group and −0.38 for the POCT group), both study groups had statistically similar pregnancy outcomes, including live delivery, term delivery, and the need for a Cesarean section. Dr. Weli notes that non-significant differences do not imply a lack of clinical difference or difference in outcomes for individual patients.
Encouraging Results and Further Research
The authors were not surprised that POCT led to on-the-spot counseling and nutrition referrals.
“I thought this would immediately translate to better pregnancy outcomes in those who were tested at the point of care, but the determinants of pregnancy outcomes are multifactorial, and the sample size was small,” Dr. Weli says.
The study site cares for underserved people who may be lost to follow-up, a pattern that became more evident during the COVID-19 pandemic. A1C POCT began just before the pandemic as a useful tool to prevent avoidable pregnancy complications. OB/GYN providers followed A1C results with immediate referrals and on-the-spot patient counseling to engage the patients in their care.
“Unlike blood glucose, A1C provides a long-term picture of glycemic control. In pregnancy, A1C might be better than in nonpregnant status due to faster turnover of red blood cells, which makes a high A1C in pregnancy a red flag necessitating immediate intervention,” Dr. Weli explains. “While A1C does not replace standardized blood glucose monitoring in pregnancy, it certainly can be an additional tool to improve the care of pregnant women.”
Drs. Weli and Farnsworth recommend further, larger studies to investigate whether A1C POCT improves outcomes in underserved and high-resource patient populations.
