Pregravid HbA1c and Glucose Measurement to Rule Out Future Gestational Diabetes Mellitus and Reduce the Need for Oral Glucose Tolerance Testing in Pregnancy
Bibliographic record
Abstract
The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) has recommended universal screening for gestational diabetes mellitus (GDM) by oral glucose tolerance test (OGTT) in all pregnant women (1). However, concern has been raised that this recommendation may pose a resource challenge for health care systems (2). Recognizing that women who develop GDM have chronic metabolic dysfunction that predates their pregnancy (3), we hypothesized that measurement of pregravid HbA1c or glucose may provide the capacity to rule out GDM in low-risk women and thereby reduce the overall OGTT burden in pregnancy. To test this hypothesis, we conducted a population-based retrospective cohort study using real-world data for Ontario, the most populous province in Canada. With administrative databases that track health care utilization, we identified all women in Ontario without preexisting diabetes who had pregravid measurement of HbA1c or glucose before singleton live-birth pregnancies between January 2008 and December 2015. Pregravid HbA1c or glucose was measured at median 1.4 years (interquartile range 1.03–2.05 years) before pregnancy in 334,829 women, including 20,221 who developed GDM. For this study, the women were randomly assigned to either derivation ( n = 167,401) or validation ( n = 167,428) cohorts to evaluate the capacity of these pregravid glycemic measurements for predicting GDM. In the derivation cohort, pregravid …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".