Reddy R, Bhattacharya S. Glycated hemoglobin and risk stratification in gestational diabetes: An editorial perspective. World J Diabetes 2026; 17(10): 117696 [DOI: 10.4239/wjd.v17.i10.117696]
Corresponding Author of This Article
Saptarshi Bhattacharya, Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, Delhi, India. saptarshi515@gmail.com
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Health Care Sciences & Services
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editorial
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Reddy R, Bhattacharya S. Glycated hemoglobin and risk stratification in gestational diabetes: An editorial perspective. World J Diabetes 2026; 17(10): 117696 [DOI: 10.4239/wjd.v17.i10.117696]
World J Diabetes. Oct 15, 2026; 17(10): 117696 Published online Oct 15, 2026. doi: 10.4239/wjd.v17.i10.117696
Glycated hemoglobin and risk stratification in gestational diabetes: An editorial perspective
Ravindranath Reddy, Saptarshi Bhattacharya
Ravindranath Reddy, Department of Endocrinology, Vasavi Endocrinology and Diabetes Clinic, Kurnool 518005, Andhra Pradesh, India
Saptarshi Bhattacharya, Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, Delhi, India
Author contributions: Bhattacharya S conceptualized and edited the manuscript; Reddy R and Bhattacharya S reviewed and synthesized the relevant literature; Reddy R prepared the initial manuscript. Both authors approved the final version and take responsibility for the content.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Saptarshi Bhattacharya, Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, Delhi, India. saptarshi515@gmail.com
Received: December 15, 2025 Revised: January 16, 2026 Accepted: February 11, 2026 Published online: October 15, 2026 Processing time: 293 Days and 10.9 Hours
Abstract
The diagnosis of gestational diabetes mellitus (GDM) is based on an oral glucose tolerance test (OGTT) performed according to the Carpenter-Coustan or the International Association of Diabetes and Pregnancy Study Groups criteria. Although universally recommended, the OGTT has limitations, including logistical challenges, poor reproducibility, and inability to detect antecedent glycemic exposure. These shortcomings have prompted interest in alternative markers such as glycated hemoglobin (HbA1c), alone or in combination with fasting plasma glucose. The established role of HbA1c, however, remains limited to ruling out pregestational diabetes in the first trimester. Additionally, elevated values in early pregnancy that do not reach diagnostic thresholds for diabetes may help identify women at risk of developing GDM and related complications. Currently, HbA1c is not used to diagnose GDM at 24-28 weeks because it underestimates maternal glycemia due to pregnancy-related hematologic changes. Emerging evidence indicates that elevated HbA1c at this gestational age independently predicts adverse perinatal outcomes beyond GDM status itself. While OGTT remains the standard for diagnosing GDM, this editorial explores the current evidence on the possible role of HbA1c as a complementary tool for risk stratification. HbA1c ≥ 5.9% (41 mmol/mol) appears to identify women at increased risk of adverse outcomes in both early and late pregnancy. However, prospective studies are needed before HbA1c can be integrated into risk-based care pathways.
Core Tip: Glycated hemoglobin (HbA1c) is unreliable for diagnosing gestational diabetes mellitus (GDM) because pregnancy alters red cell turnover and induces hematologic variability, yet rising evidence suggests it may still offer prognostic value. Early-pregnancy HbA1c above 5.9% predicts later GDM, while mid- and late-pregnancy values above 5.7-5.9 percent correlate with fetal overgrowth, hypertensive disorders, cesarean delivery, and postpartum dysglycemia. Although not a replacement for the oral glucose tolerance test, HbA1c may help identify women at heightened metabolic risk. More studies are needed before HbA1c can be integrated into risk-stratification algorithms for GDM care.
