5.3.11 Hemoglobin A1c (HbA1c) Glucose Testing in Surrogate Medical Screening

1. What is Hemoglobin A1c (HbA1c)?

Hemoglobin A1c (HbA1c) is a blood test that measures average blood sugar levels over the past 2-3 months. It helps determine how well the body regulates glucose and is commonly used to diagnose prediabetes and diabetes.

2. How Does It Work?

When there’s sugar in your blood, some of it attaches to hemoglobin, the protein in your red blood cells. The HbA1c test measures how much of your hemoglobin has sugar attached to it. The higher the percentage, the higher your average blood sugar has been over time.

HbA1c Interpretation:

HbA1c Level	Blood Sugar Status
Less than 5.7%	Normal
5.7% – 6.4%	Prediabetes
6.5% or higher	Diabetes

3. Why Is HbA1c Testing Important in Surrogacy?

As part of the medical screening process, surrogates are tested for HbA1c to make sure their blood sugar is well controlled. This is important because pregnancy naturally puts extra pressure on the body’s ability to regulate glucose.

If blood sugar is too high, it can increase the risk of complications like gestational diabetes, preeclampsia, or even issues with the baby’s growth. That’s why clinics and intended parents want to be sure a surrogate is starting out in a healthy range.

4. What If the HbA1c Level is Abnormal?

If HbA1c Is Between 5.7% and 6.4% (Prediabetes Range)

This doesn’t always mean automatic disqualification. It depends on the full picture.

• The clinic will look at the cause. Sometimes elevated levels are linked to diet, weight, or insulin resistance.
• More testing may be ordered, like a fasting glucose test or a glucose tolerance test.
• Lifestyle changes may be recommended, such as improving diet, increasing physical activity, or losing a few pounds.
• Retesting may be possible. In some cases, the surrogate is placed on hold and given time to lower her HbA1c before trying again. If levels improve, she may still be cleared to move forward.

If HbA1c Is 6.5% or Higher (Diabetes Range)

In most cases, this is considered a disqualifier. Uncontrolled or borderline diabetes comes with a high risk of complications during pregnancy, and for safety reasons, clinics typically won’t approve surrogates with levels in this range—unless there are exceptional circumstances and it's medically well-managed (which is rare).