Abstract Aims To investigate the role of glycosylated hemoglobin in assisting the oral glucose tolerance test for gestational diabetes mellitus (GDM) diagnosis in Asian populations. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2020. Review Manager was applied to assess the quality of studies and risk of bias. MetaDiSc was used to measure diagnostic odds ratio, sensitivity, specificity, positive and negative likelihood ratios, area under receiving operating characteristic curve, and heterogeneity. Results A total of 19 original studies (32?669 women) were retrieved. The diagnostic efficiency of glycosylated hemoglobin was quantified from 4.5% to 6.0%. The pooled sensitivity (0.624, 0.609–0.638) and specificity and (0.624, 0.617–0.631) achieved optimal equilibrium at 5.0%. High sensitivity (0.911, 0.902–0.920) and low negative likelihood ratio (0.431, 0.365–0.508) at 4.6% as the rule‐out cut‐off, while with limited sensitivity, high specificity (0.990, 0.986–0.993) and positive likelihood ratio (8.309, 4.251–16.242) occurred at 5.8% as the rule‐in cut‐off. Heterogeneity was detected in parts of subgroup analyses (I2?>?50%). The diagnostic odds ratio and 95% confidence interval performance were better in the population with risk factors (6.314, 3.543–11.254) than those without (4.178, 2.332–7.488). Conclusions Glycosylated hemoglobin is a potential tool in assisting GDM diagnosis in Asian populations, which has a better applicability based on the rule‐out and rule‐in algorithm (4.6%–5.8%), particularly for pregnant women with risk factors.
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