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Apata T, Samuel D, Valle L, Crimmins SD. Type 1 Diabetes and Pregnancy: Challenges in Glycemic Control and Maternal-Fetal Outcomes. Semin Reprod Med 2024. [PMID: 39379044 DOI: 10.1055/s-0044-1791704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Managing type 1 diabetes during pregnancy presents significant challenges due to physiological and hormonal changes. These factors contribute to major changes in insulin sensitivity, complicating efforts to achieve and sustain optimal blood glucose levels. Poorly controlled glucose levels during pregnancy can result in diabetic embryopathy and elevate the risks of maternal complications such as hypertensive disorders and diabetic ketoacidosis. Fetal complications may include preterm birth, fetal demise, and admission to neonatal intensive care units. It is essential to recognize that there is no universal approach to managing glycemic control in pregnant women with T1DM and care should be individualized. Effective management requires a multidisciplinary approach involving regular monitoring, adjustments in insulin therapy, dietary modifications, and consistent prenatal care. Continuous glucose monitoring has emerged as a valuable tool for real-time glucose monitoring, facilitating tighter glycemic control. Education and support for self-management are important in addressing these challenges. Future developments in technology and personalized approaches to care show promising potential for advancing diabetes management during pregnancy. This provides a comprehensive overview of current literature on the challenges with the management of T1DM during pregnancy, focusing on its impact on maternal and neonatal outcomes and highlighting effective strategies for achieving optimal glycemic control.
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Affiliation(s)
- Tejumola Apata
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Dennis Samuel
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Laticia Valle
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sarah D Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
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Peng J, Zhang L, Zheng L, Mai Z, Song L, Liu Q, Bi J, Qin X, Fang Q, Chen G, Fan G, Liu G, Wang Y. Association between hemoglobin A1c trajectory during pregnancy and adverse birth outcomes among non-gestational diabetic women. Acta Diabetol 2024; 61:1225-1230. [PMID: 38733384 DOI: 10.1007/s00592-024-02283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/23/2024] [Indexed: 05/13/2024]
Abstract
AIMS Previous studies have shown that higher hemoglobin A1c (HbA1c) levels within the normal range during pregnancy can increase the risk of adverse birth outcomes. However, the effects of the longitudinal HbA1c trajectory during pregnancy on adverse birth outcomes among non-gestational diabetic women are poorly characterized. We aimed to identify HbA1c trajectory during pregnancy among non-gestational diabetic women and to estimate their associations with adverse birth outcomes. METHODS Data was extracted from the Information System of Guangdong Women and Children Hospital, China, from January 2017 to July 2022. This study involved 13,979 women who did not have gestational diabetes mellitus and underwent repeated HbA1c measurements during pregnancy. Latent mixture modeling was used to identify HbA1c trajectory groups. Logistic regression was applied to explore the associations between HbA1c trajectory groups and adverse birth outcomes, including preterm delivery, low birth weight, macrosomia, small for gestational age, and large for gestational age (LGA). RESULTS Three HbA1c trajectory groups were identified: low-stable (range 4.0% [20 mmol/mol]-4.4% [25 mmol/mol]), moderate-stable (range 4.6% [27 mmol/mol]-5.1% [32 mmol/mol]), and elevated-increasing (range 5.0% [31 mmol/mol]-5.6% [38 mmol/mol]). Compared with the low-stable HbA1c group, the elevated-increasing group had a higher risk of preterm delivery and LGA. The adjusted OR (95% CIs) were 1.67 (1.13, 2.49) and 1.47 (1.01, 2.12) for preterm delivery and LGA, respectively. CONCLUSIONS Among non-gestational diabetic women, the elevated-increasing HbA1c trajectory group was associated with a higher risk of preterm delivery and LGA. This finding emphasizes the importance of maintaining optimal HbA1c levels throughout pregnancy.
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Affiliation(s)
- Jing Peng
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Li Zhang
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Lijuan Zheng
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Zixia Mai
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China
| | - Qing Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China
| | - Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China
| | - Xiya Qin
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China
| | - Qing Fang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China
| | - Guozhen Chen
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Gaojie Fan
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China.
| | - Guocheng Liu
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, 510010, China.
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, China
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Powers Carson J, Arora J, Carter E. Glycated Albumin to Predict Adverse Neonatal Outcomes among Women with Diabetes and Overweight or Obese Body Mass Index. J Appl Lab Med 2024:jfae079. [PMID: 39087706 DOI: 10.1093/jalm/jfae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/28/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Glycated albumin (GA) has shown promise in predicting risk of adverse neonatal outcomes (ANO) in pregnant women with type 2 diabetes (T2DM) and gestational diabetes (GDM). However, previous studies showing a negative correlation between GA and body mass index (BMI) suggest that lower predictive cutoffs may be needed in populations with elevated BMI. METHODS We performed a case-control study of prospectively enrolled pregnant women with T2DM or GDM and BMI ≥25 kg/m2 matched to biobanked controls without diabetes. Serum collected during the second and/or third trimesters was used to measure the percentage of GA (% GA). Receiver operating characteristic (ROC) curves were used to examine % GA to predict an ANO composite, including macrosomia, hypoglycemia, respiratory distress syndrome, and/or hyperbilirubinemia for the second and third trimesters. RESULTS The median BMIs for cases and controls were 34.0 and 31.0 kg/m2, respectively. The area under the ROC curve to predict the ANO composite was significant for second trimester values but ambiguous for third trimester due to its wide 95% CI. A cutoff of 12.3% GA during second trimester showed 100% sensitivity and 73% specificity. Transference of previously published reference ranges did not validate, suggesting lower ranges are needed for women with overweight/obesity. CONCLUSIONS In this pilot study, % GA shows promise to stratify pregnant patients with diabetes and obesity into risk categories for ANO with excellent predictive ability in the second trimester. If this holds in larger studies, using second trimester % GA could allow additional intervention to improve blood glucose control and minimize ANO.
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Affiliation(s)
- Jennifer Powers Carson
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Jyoti Arora
- Center for Biostatistics and Data Science, Washington University School of Medicine, St. Louis, MO, United States
| | - Ebony Carter
- Divison of Maternal-Fetal Medicine & Ultrasound, Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
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Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Epidemiology and management of gestational diabetes. Lancet 2024; 404:175-192. [PMID: 38909620 DOI: 10.1016/s0140-6736(24)00825-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Willliam H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Pilgrim Health Care Institute, Harvard Medical School, Harvard University, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Texas Woman's University, Denton, TX, USA
| | - Claire Meek
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Maria Lucia Oppermann
- Department of Obstetrics and Gynecology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus 2024; 16:e55544. [PMID: 38576690 PMCID: PMC10993087 DOI: 10.7759/cureus.55544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Pregnancy affects many organ systems and causes significant physiological changes that are mainly caused by changes in hormone levels. This review explores the complex interactions between pregnancy-related hormonal changes and renal function, providing insights into the practical applications of these relationships. Extensive literature searches were conducted, combining data from several sources to produce thorough knowledge. Essential discoveries include changes in renal hemodynamics, calcium/phosphorus level variations, thyroid gland hypertrophy, changed function, and cardiovascular adaptations. The review also addresses how sex hormones affect immunological responses, emphasizing their importance for conditions like multiple sclerosis. Additionally impacted is the gastrointestinal tract, which results in symptoms like nausea and heartburn. Comprehending these physiological changes is essential for proficient therapeutic handling, guaranteeing the best possible health for both the mother and the fetus. The study emphasizes the importance of specialized medical treatment during pregnancy and calls for more investigation to clarify the intricacies of these physiological changes.
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Affiliation(s)
- Sohan B Jee
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe) Wardha, Wardha, IND
| | - Anupama Sawal
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe) Wardha, Wardha, IND
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Pang WW, Hinkle SN, Wu J, Stallcup P, Tsai MY, Sacks DB, Zhang C. A Longitudinal Study of Plasma Glycated Albumin across Pregnancy and Associations with Maternal Characteristics and Cardiometabolic Biomarkers. Clin Chem 2023; 69:1420-1428. [PMID: 37932245 DOI: 10.1093/clinchem/hvad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Glycated albumin (GA) has recently been proposed as a screening marker for diabetes among non-pregnant individuals. However, data on GA during pregnancy are sparse and lacking among women of diverse race/ethnicity. We investigated longitudinal concentrations of GA among multiracial pregnant women in the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons. METHODS We quantified GA and cardiometabolic biomarkers using longitudinal plasma samples collected at 10 to 14, 15 to 26 (fasting), 23 to 31, and 33 to 39 gestational weeks from 214 pregnant women without gestational diabetes. We examined the distribution of GA across pregnancy and its association with participants' characteristics including race/ethnicity, pre-pregnancy body mass index (ppBMI), and selected cardiometabolic biomarkers. GA trajectories were estimated using a latent class approach. RESULTS Medians (interquartile range) of GA concentrations were 12.1% (10.6%-13.4%), 12.5% (10.7%-13.8%), 12.4% (10.9%-13.5%), and 11.5% (10.4%-12.5%) at 10 to 14, 15 to 26, 23 to 31, and 33 to 39 weeks, respectively. There were no significant differences in the pattern among different race/ethnic groups (P > 0.53). A minority of women exhibited a GA trajectory characterized by a high concentration of GA at 15 to 26 weeks. GA concentrations were inversely related to ppBMI and plasma low-density lipoprotein and triglyceride concentrations, but were not significantly related to hemoglobin A1c, fasting insulin, or glucose over pregnancy. CONCLUSIONS In this study of individuals who were normoglycemic before pregnancy, plasma GA concentrations stayed relatively constant over pregnancy, decreasing only in late pregnancy. GA concentrations were inversely related to ppBMI and suboptimal lipid profiles, but did not appear to be a sensitive marker for glucose metabolism in pregnancy.
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Affiliation(s)
- Wei Wei Pang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jing Wu
- Glotech Inc., Bethesda, MD, United States
| | - Paulina Stallcup
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - David B Sacks
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Deng Y, Cheng D, Liao G, Tan X, Yang J. Trimester-specific reference intervals for hemoglobin A1c in non-diabetic pregnancy in a Chinese population. BMC Pregnancy Childbirth 2023; 23:671. [PMID: 37726666 PMCID: PMC10507880 DOI: 10.1186/s12884-023-05980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Physiological glycated hemoglobin (HbA1c) values in each trimester are not well defined. This study aimed to determine trimester-specific reference intervals for HbA1c levels in non-diabetic pregnant women in China. METHODS In this cross-sectional study, 5,042 Chinese pregnant women from 6 to 41 weeks of gestation were screened. An inclusion of 4,134 non-diabetic women was made to determine the reference intervals, they were divided into three trimesters: trimester 1 (T1), 6 weeks to 13 weeks + 6 days, trimester 2 (T2), 14 weeks to 27 weeks + 6 days, and trimester 3 (T3), 28 weeks to 41 weeks + 6 days. A total of 4,134 women (T1 n = 760, T2 n = 1,953, and T3 n = 1,421) provided blood samples which were analyzed for HbA1c concentrations. HbA1c was measured using high-performance liquid chromatography. The median and percentile (2.5th to 97.5th) for the HbA1c reference intervals were calculated for each trimester. RESULTS In total, 8,732 HbA1c measurements were taken. Reference intervals for HbA1c expressed as median and percentile (2.5th to 97.5th) for each trimester were: T1: 4.7 (4.0-5.5%), T2: 4.5 (3.9-5.3%), and T3: 4.8 (4.1-5.7%) respectively. The HbA1c levels were significantly lower in the second trimester compared to those in the first trimester (p < 0.0001), and higher in the third trimester compared to the second trimester (p < 0.0001). CONCLUSIONS The reference intervals for HbA1c levels were 3.9-5.7% with upper limits of 5.5% in the first trimester, 5.3% in the second trimester, and 5.7% in the third trimester. These findings highlight the importance of considering trimester-specific reference intervals for HbA1c in non-diabetic pregnant women to promote maternal and fetal health.
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Affiliation(s)
- Yuguo Deng
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Danling Cheng
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Guilian Liao
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Xiaoyu Tan
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Jinying Yang
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China.
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Sugawara D, Makita E, Matsuura M, Sato H, Kuwata T, Ichihashi K. Prepregnancy body mass index and glycated albumin in the third trimester may predict infant complications in gestational diabetes mellitus: a retrospective cohort study. Diabetol Int 2023; 14:280-287. [PMID: 37397905 PMCID: PMC10307751 DOI: 10.1007/s13340-023-00631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/03/2023] [Indexed: 07/04/2023]
Abstract
Background Maternal hyperglycemia, obesity, and hypertension with gestational diabetes mellitus (GDM) are risk factors for infant complications. This study aimed to investigate maternal factors and glycemic control indicators that affect infant complications in GDM. Methods We conducted a retrospective cohort study including 112 mothers with GDM and their infants. Multivariate logistic regression analysis was used to investigate the variables associated with good and adverse infant outcomes. We determined the cutoff values of variables that showed a significant difference in the multivariate logistic regression analysis for predicting infant complications by performing receiver operating characteristic curve analysis. Results In the multivariate logistic regression analysis, prepregnancy BMI and GA in the third trimester were significantly related to good and adverse infant outcomes (adjusted odds ratios [aORs], 1.62; 95% CIs 1.17-2.25, p = 0.003 and aORs, 2.77; 95% CIs 1.15-6.64, p = 0.022, respectively). The cutoff values for prepregnancy BMI and GA in the third trimester were 25.3 kg/m2 and 13.5%, respectively. Conclusions The importance of weight control before pregnancy and the usefulness of GA in the third trimester to predict infant complications were suggested in this study.
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Affiliation(s)
- Daisuke Sugawara
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-Cho, Saitama, 330-8503 Japan
| | - Eishi Makita
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-Cho, Saitama, 330-8503 Japan
| | - Misa Matsuura
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-Cho, Saitama, 330-8503 Japan
| | - Hiroaki Sato
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-Cho, Saitama, 330-8503 Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-Cho, Saitama, 330-8503 Japan
| | - Ko Ichihashi
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-Cho, Saitama, 330-8503 Japan
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9
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Reference intervals for glycated albumin during physiological pregnancy of Europid women: Evidences from a prospective observational study. Clin Chim Acta 2023; 541:117246. [PMID: 36754193 DOI: 10.1016/j.cca.2023.117246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND AIMS Glycated albumin (GA) may assess glycometabolic control over a short period of time respect to HbA1c, and its use to screen for gestational diabetes in pregnancy has been suggested. To this regard few data on reference intervals (RI) for GA on Europid women have been collected, only from cross-sectional investigations. Aim of this work has been to collect trimester-specific RI for GA in physiological pregnancies, following a longitudinal prospective study. METHODS Forty-five healthy pregnant Europid women have been enrolled for whom a GDM screening test was scheduled at 24-28 weeks, in 5 different Italian centers. Only those negative to the OGTT were included. The women had 4 successive visits at 6-10 weeks of gestation, at 16-18 weeks, at 24-28 weeks and at the end of pregnancy. ALT, AST, total bilirubin, C-reactive protein, cholinesterase, creatinine, GGT, glycated albumin, iron, total serum proteins, transferrin were measured in duplicate on aliquots of serum samples by a central laboratory. RESULTS The RI (2.5-97.5 percentiles) for GA were 11.1-14.8 % (I visit), 10.9-15.6 % (II visit), 10.6-14.1 % (III visit) and 10.7-14.3 % (IV visit). The RI of other biomarkers confirmed previously published data. The RI for serum cholinesterase we present are novel, and were 5049-9906 U/L (Iv), 4212-8965 U/L (IIv), 3518-8470 U/L (IIIv) and 3945-8727 U/L (IVv). CONCLUSIONS Trimester-specific RI are important for using GA and serum cholinesterase in pregnancy. However, considering the high inter-individual variability of both markers, the use of longitudinal interpretations of the individual variations of both proteins during pregnancy should be preferred.
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Punnose J, Malhotra RK, Sukhija K, Rijhwani RM, Sharma A, Choudhary N, Vij P, Joseph R. Establishing Trimester-Specific Haemoglobin A1c Reference Intervals in Pregnant Women: A retrospective study of healthy South Asian women with normal pregnancy outcomes. Sultan Qaboos Univ Med J 2023; 23:81-89. [PMID: 36865418 PMCID: PMC9974038 DOI: 10.18295/squmj.3.2022.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/05/2021] [Accepted: 02/20/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to define trimester-specific haemoglobin A1c (HbA1c) reference intervals in healthy, pregnant South Asian women. Methods This retrospective study was conducted at St. Stephen's Hospital, Delhi, India, between January 2011 and December 2016. Healthy pregnant women were compared to a control group of healthy non-pregnant women. Pregnant participants had term deliveries of babies with appropriate gestational weights. The HbA1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2) and third (T3) trimester groups. Statistical tests were used to obtain the normal HbA1c reference values and were considered significant when P <0.05. Results This study included a total of 1,357 healthy pregnant women and a control group of 67 healthy, non-pregnant women. Pregnant women had a median HbA1c of 4.8% (4-5.5%) or 32 mmol/mol (20-39 mmol/mol); non-pregnant women had a median HbA1c of 5.1% (4-5.7%) or 29 mmol/mol (20-37 mmol/mol; P <0.001). The HbA1c levels for the T1, T2 and T3 groups were 4.9% (4.1-5.5%) or 30 mmol/mol (21-37 mmol/mol), 4.8% (4.5-5.3%) or 29 mmol/mol (20-34 mmol/mol) and 4.8% (3.9-5.6%) or 29 mmol/mol (19-38 mmol/mol), respectively. The HbA1c values were significant when comparing T1 versus T2 (P <0.001), T1 versus T3 (P = 0.002) and T1 versus the non-pregnant group (P = 0.001). However, T2 versus T3 was not significant (P = 0.111). Conclusion Compared to non-pregnant women, HbA1c levels were lower in pregnant women, despite women in the T2 and T3 groups having a higher body mass index than the women in the T1 and non-pregnant groups. Further research is recommended to understand the factors responsible and validate these findings.
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Affiliation(s)
- John Punnose
- Department of Endocrinology, St. Stephen’s Hospital, New Delhi, India,Corresponding Author’s e-mail:
| | | | - Komal Sukhija
- Department of Endocrinology, St. Stephen’s Hospital, New Delhi, India
| | | | - Asha Sharma
- Department of Obstetrics & Gynecology, St. Stephen’s Hospital, New Delhi, India
| | - Naimaa Choudhary
- Department of Obstetrics & Gynecology, St. Stephen’s Hospital, New Delhi, India
| | - Prassan Vij
- Department of Reproductive Medicine, St. Stephen’s Hospital, New Delhi, India
| | - Renuka Joseph
- Department of Biochemistry, St. Stephen’s Hospital, New Delhi, India
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11
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Rooney MR, Zhang S, Fang M, Minhas AS, Wallace AS, Grams ME, Echouffo-Tcheugui JB, Christenson RH, Selvin E. Performance of glycated albumin as a biomarker of hyperglycemia in pregnancy: Results from the National Health and Nutrition Examination Survey 1999-2004. Clin Biochem 2023; 112:67-70. [PMID: 36414047 PMCID: PMC9870942 DOI: 10.1016/j.clinbiochem.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
AIM We sought to evaluate the performance of glycated albumin (GA) as a measure of hyperglycemia in pregnant women. METHODS We used data from 555 pregnant women aged 20-40 years who participated in NHANES 1999-2004 and did not report a pre-pregnancy diagnosis of diabetes. We used Pearson's correlations and evaluated the area under the curve (AUC) for GA to detect elevated concentrations of random glucose, HbA1c, or fasting glucose (subset). We compared results to 1607 nonpregnant women aged 20-40 without diabetes. RESULTS In pregnant women, 1.9 % had HbA1c ≥ 39 mmol/mol (≥5.7 %), 9.1 % had random glucose ≥ 5.3 mmol/L (≥95 mg/dL), and 10.7 % had fasting glucose ≥ 5.3 mmol/L. In pregnancy, GA was poorly correlated with HbA1c (r = 0.08) and random glucose (r = 0.17). BMI was positively associated with HbA1c (r = 0.33) and random glucose (r = 0.25) but was inversely associated with GA (r = -0.27). GA had poor discrimination for detecting hyperglycemia in pregnant women, defined as HbA1c ≥ 39 mmol/mol (AUC = 0.634) or random glucose ≥ 5.3 mmol/L (AUC = 0.628). Similar patterns were observed among nonpregnant women. CONCLUSIONS GA is not a sensitive test to screen for hyperglycemia in pregnancy. GA was inversely associated with adiposity in pregnant women without diabetes. Pregnancy-related weight gain may complicate interpretation of repeated GA measurements.
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Affiliation(s)
- Mary R Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Amelia S Wallace
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Morgan E Grams
- Division of Precision Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Robert H Christenson
- Department of Pathology, University of MD School of Medicine, Baltimore, MD, United States
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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12
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Omokhodion OV, Kuti MA, Odukogbe ATA, Omokhodion FO. Fetal glycated albumin levels in offspring of obese women. Int J Gynaecol Obstet 2023; 161:1053-1060. [PMID: 36606743 DOI: 10.1002/ijgo.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the association between maternal obesity and fetal glycated albumin (GA) levels among pregnant women. METHODS A comparative, cross-sectional study of 59 consenting, normoglycemic, pregnant women, who met the criteria for maternal obesity, attending the antenatal clinic of the University College Hospital, Nigeria, from June 2019 to December 2019. They were recruited at 36 weeks of gestation, followed up until delivery, and compared with 58 nonobese, normoglycemic pregnant controls. At delivery, blood samples were taken from the mothers and from the umbilical cords of their newborns for serum GA assay. Maternal and newborn variables were recorded, and comparisons were made using χ2 tests, independent t tests, odds ratios, analysis of variance, and Pearson correlates. Statistical significance was set at P < 0.05. RESULTS The odds of elevated newborn GA were 3.21 times higher in obese women compared with nonobese women (P = 0.005) and 5-min APGAR scores were higher in the newborns of nonobese women (P = 0.039). There was a significant correlation between maternal and neonatal GA for all participants (r = 0.346, P = 0.000). CONCLUSION These findings suggest that maternal obesity is associated with elevated fetal GA and low APGAR scores at 5 min in normoglycemic women.
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Affiliation(s)
| | - Modupe A Kuti
- Department of Chemical Pathology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Akin-Tunde A Odukogbe
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Folashade Olufunke Omokhodion
- Department of Community Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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13
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Toft JH, Dalen I, Skadberg Ø, Gøransson L, Økland I, Bleskestad IH. Glycated albumin and continuous glucose monitoring metrics across pregnancy in women with pre-gestational diabetes. Endocrinol Diabetes Metab 2022; 5:e376. [PMID: 36121204 PMCID: PMC9659665 DOI: 10.1002/edm2.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Glycated albumin (GA), a biomarker reflecting short-term glycaemia, may be useful to assess glycaemic control in pregnancy. We examined the association between GA and continuous glucose monitoring (CGM) metrics across gestation. METHODS In this prospective cohort study including 40 women with pre-gestational diabetes, blood samples for analysis of GA and glycated haemoglobin A1c (HbA1c) were collected at pregnancy week 12, 20, 24, 28, 32 and 36. In the CGM-group (n = 19), CGM data were collected from first trimester until pregnancy week 36. Receiver operating characteristic (ROC) curves were used to assess the accuracy of GA and HbA1c to detect poor glycaemic control, using CGM metrics as the reference standard. This study was conducted at Stavanger University Hospital, Norway, in 2016-2018. RESULTS Glycaemic control improved across gestation with more time spent in target range, coinciding with decreased glycaemic variability and lower mean GA level. There was statistically significant correlation between GA and most CGM metrics. The area under the ROC curves (AUC) for detecting time in range <70% and time above range >25% for the pregnancy glucose target 63-140 mg/dl (3.5-7.8 mmol/L) were 0.78 and 0.82 for GA, whereas AUCs of 0.60 and 0.72 were found for HbA1c, respectively. CONCLUSIONS Higher GA levels were associated with less time spent in target range, more time spent in the above range area and increased glycaemic variability. GA was more accurate than HbA1c to detect time above range >25% and time in range <70%.
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Affiliation(s)
- Johanne Holm Toft
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway,Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Ingvild Dalen
- Section of Biostatistics, Department of ResearchStavanger University HospitalStavangerNorway
| | - Øyvind Skadberg
- Department of Medical BiochemistryStavanger University HospitalStavangerNorway
| | - Lasse Gunnar Gøransson
- Department of Internal MedicineStavanger University HospitalStavangerNorway,Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Inger Økland
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway,Department of Caring and EthicsUniversity of StavangerStavangerNorway
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14
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Guo ZH, Tian HL, Zhang XQ, Zhang DH, Wang ZM, Wang K, Su WW, Chen F. Effect of anemia and erythrocyte indices on hemoglobin A1c levels among pregnant women. Clin Chim Acta 2022; 534:1-5. [PMID: 35803335 DOI: 10.1016/j.cca.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anemia is a common disorder among pregnant women; however, the effect of anemia on hemoglobin A1c (HbA1c) levels has not been adequately explored. We aim to examine the influence of anemia on the HbA1c concentration and investigate the relationship between erythrocyte indices and HbA1c levels during pregnancy. METHODS We performed a retrospective analysis of 1369 pregnant Chinese women. The clinical and analytical data were collected. Independent t-test and Analysis of Variance were used for comparative studies, and multiple linear regression analysis was used to identify the association between erythrocyte indices and HbA1c. RESULTS The differences in HbA1c between non-anemia and mild anemia were negligible, and the differences in HbA1c between non-anemia and moderate anemia were well within the allowable variability for clinical practice (≥0.5% absolute changes). Mean corpuscular hemoglobin (MCH) correlated with HbA1c significantly, independent of pregnancy, trimester, and anemia. The distinction of HbA1c levels between grades of Hb became no significant (P = 0.955), while differences between trimesters persisted after adjusting for MCH. CONCLUSION Mild and moderate anemia should not be the primary concern when using HbA1c to monitor blood glucose in pregnancy. MCH showed negative correlations with HbA1c independently, suggesting a previously unknown mechanism affecting HbA1c levels.
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Affiliation(s)
- Zong-Hui Guo
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China.
| | - Huai-Liang Tian
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Xiao-Qian Zhang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Deng-Han Zhang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Zhi-Min Wang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Kun Wang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Wen-Wen Su
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Fei Chen
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
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15
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Sugawara D, Sato H, Makita E, Kuwata T, Takagi K, Ichihashi K. Clinical usefulness of glycated albumin and glycated albumin-to-glycated hemoglobin ratio of gestational diabetes mellitus in late pregnancy for predicting infant complications. Pediatr Neonatol 2022; 63:239-246. [PMID: 35185003 DOI: 10.1016/j.pedneo.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/01/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) with poorly controlled glycemia is associated with poor pregnancy outcomes. However, adequate markers for glycemic control in GDM have not been fully evaluated. METHODS We retrospectively studied 77 patients with GDM and their infants. Mean glycated albumin (GA), glycated hemoglobin (HbA1c), and GA/HbA1c in GDM were compared between two groups stratified by the presence or absence of infant complications (complications or non-complications). We assessed the predictability of infant complications in GA, HbA1c, and GA/HbA1c of women with GDM by receiver operating characteristic analysis (ROC). RESULTS In complications and non-complications, GA and GA/HbA1c were significantly associated with neonatal hypoglycemia (13.9% vs. 13.0%, p < 0.001 and 2.49 vs. 2.33, p < 0.001, respectively), respiratory disorders (13.7% vs. 13.2%, p = 0.013 and 2.48 vs. 2.34, p < 0.001, respectively), myocardial hypertrophy (14.5% vs. 13.0%, p < 0.001 and 2.59 vs. 2.33, p < 0.001, respectively), and large for gestational age (14.5% vs. 13.1%, p < 0.001 and 2.58 vs. 2.34, p < 0.001, respectively). Compared with each infant complication in ROC, GA and GA/HbA1c had higher area under the curve than HbA1c. Especially, GA and GA/HbA1c had highest AUC in predicting myocardial hypertrophy and large for gestational age (GA; 0.92 and 0.92, GA/HbA1c; 0.91 and 0.86, respectively). Although statistically significant positive correlations were found between GA and GA/HbA1c and the number of infant complications (GA: r = 0.417, p < 0.001; GA/HbA1c: r = 0.408, p < 0.001), their correlations were weak. CONCLUSION Compared with HbA1c, GA and GA/HbA1c of GDM in late pregnancy might be useful for predicting infant complications arising from GDM.
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Affiliation(s)
- Daisuke Sugawara
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Saitama 330-8503, Japan.
| | - Hiroaki Sato
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Saitama 330-8503, Japan
| | - Eishi Makita
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Saitama 330-8503, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Saitama 330-8503, Japan
| | - Kenjiro Takagi
- Department of Obstetrics and Gynecology, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Saitama 330-8503, Japan
| | - Ko Ichihashi
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma-cho, Saitama 330-8503, Japan
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16
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Liabsuetrakul T, Sriwimol W, Jandee K, Suksai M, Dyereg J. Relationship of anthropometric measurements with glycated hemoglobin and 1-h blood glucose after 50 g glucose challenge test in pregnant women: A longitudinal cohort study in Southern Thailand. J Obstet Gynaecol Res 2022; 48:1337-1347. [PMID: 35261106 DOI: 10.1111/jog.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
AIMS To assess correlations of anthropometric measurements with glycated hemoglobin (HbA1c) and 1-h blood glucose after a 50 g glucose challenge test during the first and late second trimesters and explore their relationships of anthropometric measurements with neonatal birth weight. METHODS A longitudinal study was conducted among pregnant Thai women with gestational age ≤14 weeks. Anthropometric measurements, using body mass index, body compositions, and circumferences, and skinfold thickness, were measured at four-time points: ≤14, 18-22, 24-28, and 30-34 weeks of gestation. HbA1c and 1-h blood glucose were examined at ≤14 and 24-28 weeks. Neonatal birth weight was recorded. RESULTS Of 312 women, HbA1c was more correlated with anthropometric measurements during pregnancy than 1-h blood glucose. At 24-28 weeks, women with high/very high body fat percentage were more likely to have higher HbA1c. Women with high subscapular skinfold thickness were more likely to have higher 1-h blood glucose at ≤14 and 24-28 weeks. High hip circumference significantly increased neonatal birth weights. CONCLUSION Anthropometric measurements were longitudinally correlated with HbA1c and 1-h blood glucose, higher in the late second than first trimesters, as well as neonatal birth weight. The mechanisms to explain the relationship of different anthropometric measurements are required to be further studied.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wilaiwan Sriwimol
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kasemsak Jandee
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Department of Community Public Health, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Manaphat Suksai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jaeuddress Dyereg
- Obstetrics and Gynecology Division, Naradhiwas Rajanagarindra Hospital, Narathiwat, Thailand
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17
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Toft JH, Bleskestad IH, Skadberg Ø, Gøransson LG, Økland I. Glycated albumin in pregnancy: LC-MS/MS-based reference interval in healthy, nulliparous Scandinavian women and its diagnostic accuracy in gestational diabetes mellitus. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:123-131. [PMID: 35148229 DOI: 10.1080/00365513.2022.2033827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Glycated albumin (GA) may be a useful biomarker of glycemia in pregnancy. The aim of this study was to establish the reference interval (RI) for GA, analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), in healthy, nulliparous pregnant women. In addition, we assessed the accuracy of GA and glycated hemoglobin A1c (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM). Finally, we explored the prevalence of GDM in healthy nulliparas, comparing three diagnostic guidelines (WHO-1999, WHO-2013 and the Norwegian guideline). The study was carried out at Stavanger University Hospital, Norway, and included a study population of 147 pregnant nulliparous women. An oral glucose tolerance test (OGTT) was performed and used as the gold standard for GDM diagnosis. Blood samples for analysis of GA and HbA1c were collected at pregnancy week 24-28. A nonparametric approach was chosen for RI calculation, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of GA and HbA1c. The established RI for GA in 121 pregnant women was 7.1-11.6%. The area under the ROC curves (AUCs) were 0.531 (GA) and 0.627 (HbA1c). According to the WHO-1999, WHO-2013 and the Norwegian guideline, respectively, 24 (16%), 36 (24%) and 21 (14%) women were diagnosed with GDM. Only nine women (6%) fulfilled the GDM-criteria of all guidelines. In conclusion, we established the first LC-MS/MS-based RI for GA in pregnant women. At pregnancy weeks 24-28, neither GA nor HbA1c discriminated between those with and without GDM. Different women were diagnosed with GDM using the three guidelines.
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Affiliation(s)
- Johanne Holm Toft
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Øyvind Skadberg
- Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Lasse Gunnar Gøransson
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
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18
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Rao C, Ping F. Comparison of insulin requirements across gestation in women with hyperglycemia in pregnancy: A prospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1013663. [PMID: 36339424 PMCID: PMC9633005 DOI: 10.3389/fendo.2022.1013663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study is to explore the daily insulin dose and the percentage change in preprandial and basal insulin dosage of women with different types of hyperglycemia in pregnancy (HIP) during the whole gestation and postpartum period. METHODS A total of 121 subjects with HIP requiring insulin therapy were enrolled from a prospective cohort consisted of 436 pregnant women with hyperglycemia. The subjects were divided into three groups: Group 1 [type 1 diabetes mellitus (T1DM) and maturity onset diabetes of the young (MODY)], Group 2 [type 1 diabetes mellitus (T2DM)], and Group 3 [gestation diabetes mellitus (GDM)]. The primary study measurements included daily dose and percentage of different types of exogenous insulin requirements across gestation in different groups. RESULTS Insulin total daily dosage of Group 1 was highest among the three groups and increased significantly from the first to the second/third trimester. Percentage of preprandial insulin increased from 53.8% (46.7, 60.0) and 54.5% (42.3, 62.9) in the first trimester to 63.6% (54.9, 75.0) and 67.2% (51.8, 73.7) in the second/third trimester in Group 1 and Group 2. All subjects with T1DM and 18.6% of subjects with T2DM still required insulin administration after delivery, with a 26.9% (19.0, 46.0) and 36.7% (26.9, 52.6) decrease in total insulin dose, respectively, whereas subjects with GDM and MODY weaned off insulin completely. CONCLUSION The insulin requirements for pregnancy complicated with T1DM and MODY were higher than those for T2DM and GDM. In the subjects with PGDM, the insulin requirement and percentage of preprandial insulin increased gradually from early to mid- and late pregnancy.
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Affiliation(s)
- Chong Rao
- Department of Endocrinology, Beijing ChuiYangLiu Hospital, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Endocrinology Assigned by Ministry of Health, Beijing, China
- *Correspondence: Fan Ping,
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Lu Y, Huo Z, Ge F, Luo J. Pregnancy Status Is Associated with Lower Hemoglobin A1c among Nondiabetes Women in the United States from NHANES 2005-2016. Int J Endocrinol 2022; 2022:4742266. [PMID: 35111221 PMCID: PMC8803451 DOI: 10.1155/2022/4742266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It has been verified that the incidence rate of diabetes mellitus (DM) is sharply increased in pregnant female adults. However, the relationship between pregnant status and hemoglobin A1c (HbA1c) in nondiabetes women remains unclear. METHODS We conducted a cross-sectional study of 7762 participants in the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Multivariable linear regression models were performed to evaluate the associations between pregnant status with HbA1c and serum glucose in nondiabetes women. RESULTS HbA1c was significantly lower in the pregnant group than in the nonpregnant group. There was a negative association between urine pregnancy test and HbA1c in all three models (model 1: β = -0.23, 95% CI: (-0.18 to -0.27); model 2: β = -0.20, 95% CI: (-0.15 to -0.24); model 3: β = -0.24, 95% CI: (-0.20 to -0.29)). In the subgroup analysis stratified by age, this negative association existed in all age subgroups (age <20: β = -0.20, 95% CI: (-0.04 to -0.27); age ≥20, <35: β = -0.24, 95% CI: (-0.20 to -0.29); age ≥35: β = -0.28, 95% CI: (-0.17, -0.39)). In the subgroup analysis stratified by race, the negative associations steadily existed in different subgroups (Mexican American:β = -0.20, 95% CI:(-0.11 to -0.29); Other Hispanic:β = -0.31, 95% CI: (-0.16 to -0.46); Non-Hispanic White: β = -0.24, 95% CI: (-0.17 to -0.31); Non-Hispanic Black: β = -0.21, 95% CI: (-0.12 to -0.31); Other races:β = -0.22, 95% CI: (-0.08 to -0.35)). On the other hand, a negative association between self-reported pregnant status and HbA1c was also found (model 1: β = -0.22, 95% CI: (-0.18 to -0.27); model 2: β = -0.19, 95% CI: (-0.15 to -0.2); model 3: β = -0.23, 95% CI: (-0.19 to -0.28)). In the subgroup analysis stratified by age, this negative association also existed in all age subgroups. CONCLUSIONS The study indicated that nondiabetes women with pregnant status had significantly lower HbA1c compared with those nonpregnant. Moreover, the negative associations between pregnant status and HbA1c steadily existed in subgroups stratified by age and gender.
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Affiliation(s)
- Yi Lu
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Huo
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Fan Ge
- First Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Jiachun Luo
- Key Laboratory of Molecular Target & Clinical Pharmacology and the State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & the Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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20
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Morton A, Teasdale S. Physiological changes in pregnancy and their influence on the endocrine investigation. Clin Endocrinol (Oxf) 2022; 96:3-11. [PMID: 34724247 DOI: 10.1111/cen.14624] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Physiological changes in pregnancy may result in significant alterations in endocrine hormone profiles, serum and urine electrolytes and endocrine gland morphology on imaging. Pregnancy-specific pathophysiological processes may also affect the results for endocrine tests. Investigation of endocrine disorders in pregnancy requires knowledge of these changes and awareness of the safety of dynamic hormone testing and imaging for the mother and foetus. OBJECTIVE This review seeks to outline the important physiological changes in pregnancy affecting reference intervals of basal and dynamic endocrine tests in pregnancy and the scenarios in which these changes are clinically significant, the pregnancy-specific disorders that may affect the investigation of endocrine disorders, and the safety of dynamic testing and imaging. CONCLUSION Awareness of the effect of physiological changes, and the potential impact of pregnancy-specific disorders of endocrine tests, and the safety of imaging is crucial to the management of endocrine disorders in pregnancy.
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Affiliation(s)
- Adam Morton
- Departments of Endocrinology and Obstetric Medicine, Mater Health, Brisbane, Queensland, Australia
| | - Stephanie Teasdale
- Departments of Endocrinology and Obstetric Medicine, Mater Health, Brisbane, Queensland, Australia
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Yuasa T, Takata Y, Aki N, Kunimi K, Satoh M, Nii M, Izumi Y, Otoda T, Hashida S, Osawa H, Aihara KI. Insulin receptor cleavage induced by estrogen impairs insulin signaling. BMJ Open Diabetes Res Care 2021; 9:9/2/e002467. [PMID: 34969688 PMCID: PMC8719150 DOI: 10.1136/bmjdrc-2021-002467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Soluble insulin receptor (sIR), which is the ectodomain of insulin receptor (IR), is present in human plasma. Plasma sIR levels are positively correlated with blood glucose levels and negatively correlated with insulin sensitivity. An in vitro model of IR cleavage shows that extracellular calpain 2 directly cleaves IR, which generates sIR, and sequential cleavage of the IRβ subunit by γ-secretase impairs insulin signaling in a glucose concentration-dependent manner. Nevertheless, sIR levels vary among subjects with normal glucose levels. RESEARCH DESIGN AND METHODS We examined sIR levels of pregnant women throughout gestation. Using an in vitro model, we also investigated the molecular mechanisms of IR cleavage induced by estradiol. RESULTS In pregnant women, sIR levels were positively correlated with estrogen levels and significantly increased at late pregnancy independent of glucose levels. Using an in vitro model, estrogen elicited IR cleavage and impaired cellular insulin signaling. Estradiol-induced IR cleavage was inhibited by targeting of calpain 2 and γ-secretase. Estrogen exerted these biological effects via G protein-coupled estrogen receptor, and its selective ligand upregulated calpain 2 expression and promoted exosome secretion, which significantly increased extracellular calpain 2. Simultaneous stimulation of estrogen and high glucose levels had a synergic effect on IR cleavage. Metformin prevented calpain 2 release in exosomes and restored insulin signaling impaired by estrogen. CONCLUSIONS Estradiol-induced IR cleavage causes cellular insulin resistance, and its molecular mechanisms are shared with those by high glucose levels. sIR levels at late pregnancy are significantly elevated along with estrogen levels. Therefore, estradiol-induced IR cleavage is preserved in pregnant women and could be part of the etiology of insulin resistance in gestational diabetes mellitus and overt diabetes during pregnancy.
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Affiliation(s)
- Tomoyuki Yuasa
- Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasunori Takata
- Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Nanako Aki
- Internal Medicine, Anan Kyoei Hospital, Anan, Japan
| | - Kotaro Kunimi
- Obstetrics and Gynecology, Anan Kyoei Hospital, Anan, Japan
| | - Miki Satoh
- Obstetrics and Gynecology, Anan Kyoei Hospital, Anan, Japan
| | - Mari Nii
- Obstetrics and Gynecology, Anan Kyoei Hospital, Anan, Japan
| | | | - Toshiki Otoda
- Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Seiichi Hashida
- Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Haruhiko Osawa
- Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Ken-Ichi Aihara
- Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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22
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Gomes-Filho IS, Trindade SC, da Cruz SS, Figueiredo ACMG, Hintz AM, Adan LFF, Cerqueira EDMM, Passos-Soares JDS, Vianna MIP, Coelho JMF, Alves CMC, Barreto ML, Seymour GJ, Loomer PM, Scannapieco FA. Mothers' high glycemic levels and the association between periodontitis and low birth weight. J Periodontol 2021; 93:954-965. [PMID: 34792204 DOI: 10.1002/jper.21-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW). METHODS 732 women took part in this case-control study; 172 were mothers of children with LBW <2,500g, and 560 were mothers of children with BW ≥2,500g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within seven days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating Odds Ratios (OR) with 95% confidence intervals (95%CI). RESULTS In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the ORadjusted was 1.55; 95%CI: 1.04-2.31; using the Gomes-Filho et al. criteria the ORadjusted was 1.91; 95%CI: 1.06-3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW. CONCLUSION Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Soraya Castro Trindade
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Simone Seixas da Cruz
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
- Health Sciences Center, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | | | | | | | | | | | | | | | | | - Maurício Lima Barreto
- Center for Data and Knowledge Integration for Health, CIDACS, Oswaldo Cruz Foundation, FIOCRUZ, Salvador, Bahia, Brazil
| | - Gregory John Seymour
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Michael Loomer
- School of Dentistry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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23
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Paleari R, Succurro E, Angotti E, Torlone E, Caroli A, Alessi E, Ceriotti F, Mosca A. Why glycated albumin decreases in pregnancy? Evidences from a prospective study on physiological pregnancies of Caucasian women. Clin Chim Acta 2021; 520:217-218. [PMID: 34089723 DOI: 10.1016/j.cca.2021.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Renata Paleari
- Dip. Di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Milano, Italy
| | - Elena Succurro
- Policlinico "Mater Domini", Università degli Studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Elvira Angotti
- Policlinico "Mater Domini", Università degli Studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Elisabetta Torlone
- MISEM, A.O. S. Maria della Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Antonella Caroli
- MISEM, A.O. S. Maria della Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | | | - Ferruccio Ceriotti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Mosca
- Dip. Di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Milano, Italy.
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24
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Chume FC, Renz PB, Hernandez MK, Freitas PAC, Camargo JL. Is there a role for glycated albumin in the diagnosis of gestational diabetes mellitus? Endocrine 2021; 72:681-687. [PMID: 33719011 DOI: 10.1007/s12020-021-02673-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies in the general population have advocated glycated albumin (GA) as a useful alternative to glycated haemoglobin (HbA1c) under conditions wherein the latter does not reflect glycaemic status accurately. There are few studies in other populations, especially in pregnant women. Therefore, the aim of this study was to assess the clinical utility of GA in the diagnosis of gestational diabetes mellitus (GDM). MATERIALS AND METHODS This diagnostic test accuracy study was performed in 149 Brazilian women at 24-28 weeks of gestation referred for an oral glucose tolerance test (OGTT) in a tertiary university hospital. Receiver Operating Characteristic (ROC) curves were used to access the performance of GA and HbA1c in the diagnosis of GDM by the reference OGTT. RESULTS GDM by OGTT (IADPSG criteria) was detected in 18.8% of participants. According to ROC analysis, the area under the curve (AUC) for GA was 0.531 (95% CI: 0.405-0.658, p = 0.065) lower than that for HbA1c [0.743 (95% CI: 0.636-0.849; p ≤ 0.001] for the detection of GDM (p = 0.004). The equilibrium cut-off value for GA was 12.6%; sensitivity and specificity in this cut-off point were 53.6% and 54.2%, respectively. CONCLUSIONS GA at 24-28 weeks of gestation does not have ability to correctly discriminate those with and without GDM. In summary, the lack of sensitivity found in our results do not support the solely use of GA in the diagnosis of GDM.
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Affiliation(s)
- Fernando Chimela Chume
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
- Faculty of Health Sciences, Universidade Zambeze, Beira, Mozambique
| | - Paula Breitenbach Renz
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
| | - Mayana Kieling Hernandez
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
| | - Priscila Aparecida Correa Freitas
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
- Laboratory Diagnosis Division, Clinical Biochemistry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-006, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil.
- Endocrinology Division and Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-006, Brazil.
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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25
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Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Prediabetes and pregnancy: Early pregnancy HbA 1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes. Diabetes Res Clin Pract 2021; 176:108868. [PMID: 34023341 DOI: 10.1016/j.diabres.2021.108868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
AIMS To assess whether early pregnancy HbA1c can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women. METHODS Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA1c was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA1c for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn. RESULTS Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA1c ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8-88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03-4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA1c whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy. CONCLUSIONS Early pregnancy HbA1c ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.
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Affiliation(s)
- Emma L Jamieson
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia
| | - Erica P Spry
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia
| | - Andrew B Kirke
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia
| | - Emma Griffiths
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Cynthia Porter
- Geraldton Regional Aboriginal Medical Service, Rifle Range Road, Rangeway, WA 6530, Australia
| | - Carly Roxburgh
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Sally Singleton
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Kylie Sterry
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, WA 6433, Australia
| | - David N Atkinson
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Julia V Marley
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia.
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26
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Agnello L, Lo Sasso B, Scazzone C, Giglio RV, Gambino CM, Bivona G, Pantuso M, Ciaccio AM, Venezia R, Vidali M, Ciaccio M. Preliminary reference intervals of Glycated Albumin in healthy Caucasian pregnant women. Clin Chim Acta 2021; 519:227-230. [PMID: 33989612 DOI: 10.1016/j.cca.2021.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Glycated albumin (GA) could represent a useful biomarker in pregnant women for diagnosing and monitoring gestational diabetes mellitus (GDM). The establishment of reference intervals (RI) is mandatory before assessing its clinical usefulness. The RIs of GA in healthy pregnant women are not well defined. The aim of the current study was to establish the RI in a cohort consisting of Caucasian pregnant women without overt diabetes mellitus or gestational diabetes mellitus. METHODS The study included 183 healthy pregnant women. GA was measured on plasma by an enzymatic method (quantILab Glycated Albumin, IL Werfen, Germany). The RI was calculated by the non-parametric and robust methods. RESULTS The RI of GA in the whole population was 10.16% (90%CI 9.60-10.70) and 15.44% (90%CI 14.90-16.90). GA levels decreased during pregnancy, with lower levels in the third trimester: 10.11 (90%CI 9.48-10.79) and 15.72 (90%CI 15.15-16.27) in the first trimester, 10.49 (90%CI 10.05-10.96) and 15.49 (90%CI 15.05-15.92) in the second trimester, 9.84 (90%CI 9.50-10.22) and 14.57 (90%CI 14.11-15.01) in the third trimester. Finally, a weak negative correlation was found between GA levels and body mass index. CONCLUSION This is the first study establishing the RIs of GA in Caucasian healthy pregnant women.
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Affiliation(s)
- Luisa Agnello
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Bruna Lo Sasso
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy; Department of Laboratory Medicine, University Hospital "P. Giaccone", Palermo, Italy
| | - Concetta Scazzone
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Rosaria Vincenza Giglio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Caterina Maria Gambino
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giulia Bivona
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Michele Pantuso
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | | | - Renato Venezia
- Unit of Gynaecology and Obstetrics, Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - Matteo Vidali
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy; Department of Laboratory Medicine, University Hospital "P. Giaccone", Palermo, Italy.
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Liu X, Wu N, Al-Mureish A. A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes. Int J Gen Med 2021; 14:1155-1165. [PMID: 33833555 PMCID: PMC8019620 DOI: 10.2147/ijgm.s296316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022] Open
Abstract
Glycosylated hemoglobin (HbA1C) and glycated albumin (GA) can be used for blood glucose management of a person with diabetes as a result of their convenience and stability. However, there is no corresponding standard for the application of glycosylated hemoglobin and glycosylated albumin in gestational diabetes mellitus (GDM). In this review, we summarize the published research and discuss three aspects of the significance of HBA1C and GA in GDM patients: screening of gestational diabetes mellitus, blood glucose monitoring and the relationship with pregnancy outcome. At present, studies suggest that HBA1C can be used as a screening indicator for pregnant women, but it cannot completely replace OGTT. HbA1C and GA can be used for blood glucose management in patients with GDM to reduce the incidence of GDM complications. However, the application of HBA1C and GA in GDM still needs more research and clinical practice support.
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Affiliation(s)
- Xinyan Liu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.,Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Abdulrahman Al-Mureish
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
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Kumar N, Kumar P, Harris N, Monga R, Sampath V. Impact of Maternal HbA1c Levels ≤6% and Race in Nondiabetic Pregnancies on Birthweight and Early Neonatal Hypoglycemia. J Pediatr 2020; 227:121-127.e3. [PMID: 32800816 DOI: 10.1016/j.jpeds.2020.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/25/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether pregnancy glycated hemoglobin (HbA1c) levels of ≤6% and maternal race impacts neonatal hypoglycemia and birthweight, and whether diabetes and beta blocker use during pregnancy additively impacts neonatal outcomes. STUDY DESIGN Retrospective chart review of 4769 infants born at ≥34 weeks; 21 482 glucose measurements were assessed. Predefined groups were infants born to mothers without documented pregnancy conditions (group N), prenatal exposure of beta blockers (group B), diabetes (group D), or both (group DB). RESULTS In group N, both in Caucasian (Caucasian, n = 1756; β = 2.6, P < .001) and African American (n = 1872; β = 2.2, P = .002) race, there was a direct relationship between pregnancy HbA1c levels and birthweight. HbA1c (aOR 1.8; 95% CI [1.3-2.5]) levels, maternal race, prematurity, cesarean delivery, and birth weight predicted hypoglycemia. Each 0.1% increase in HbA1c levels between 4.8 and 6 increased the odds of neonatal hypoglycemia by 6.4% in African American (β 0.62, SE 0.22, P = .01) and by 12.0% in Caucasian (β 1.13, SE 0.23 P < .001) population. The odds of neonatal hypoglycemia were 1.7 (group B), 2.1 (group D), and 3.1 (group DB) times higher compared with group N. CONCLUSIONS Pregnancy HbA1c levels between 4.8% and 6.0% considered acceptable during pregnancy impacts neonatal hypoglycemia and birthweight especially in Caucasian race. A third trimester HbA1c >5.2 is a potential risk factor for neonatal hypoglycemia, especially in preterm infants. Although we report new findings on the relationship between maternal HbA1c levels and neonatal outcomes, a prospective study is required to validate our findings and determine "optimal" HbA1C levels during pregnancy.
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Affiliation(s)
- Navin Kumar
- Division of Neonatology, Hurley Children's Hospital, Flint, MI.
| | - Parkash Kumar
- Department of Public Health, University of Michigan, Flint, MI
| | - Nathalee Harris
- Division of Neonatology, Hurley Children's Hospital, Flint, MI
| | - Ranjan Monga
- Division of Neonatology, Hurley Children's Hospital, Flint, MI
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29
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Sasaki H, Arata N, Tomotaki A, Yamamoto‐Hanada K, Mezawa H, Konishi M, Ishitsuka K, Saito‐Abe M, Sato M, Nishizato M, Saito H, Ohya Y. Time course of metabolic status in pregnant women: The Japan Environment and Children's Study. J Diabetes Investig 2020; 11:1318-1325. [PMID: 32083793 PMCID: PMC7477532 DOI: 10.1111/jdi.13238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS/INTRODUCTION We aimed to evaluate the metabolic status of pregnant women by assessing metabolic biomarkers of participants in the Japan Environment and Children's Study, a nationwide, multicenter, pregnancy and birth cohort. MATERIALS AND METHODS Pregnant women aged 14-50 years were studied in 15 centers across Japan. Clinical information was obtained using self-administered questionnaires. Blood samples were taken during the first two trimesters to measure metabolic biomarkers. Samples were divided into seven groups according to the weeks of pregnancy. RESULTS Among 82,972 pregnant women, 43 had only type 1 diabetes, 78 had only type 2 diabetes, 2,315 had only gestational diabetes and 354 had only dyslipidemia. Glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol and triglyceride across all the percentiles increased as prepregnancy body mass index increased, whereas high-density lipoprotein cholesterol levels across all the percentiles decreased as body mass index increased. Glycated hemoglobin was high in participants with type 1 diabetes or type 2 diabetes only, but not in those with gestational diabetes or hyperlipidemia only. Participants with type 2 diabetes or dyslipidemia only had high triglyceride in the first trimester, which then decreased in the second trimester. Participants with type 2 diabetes only also showed low high-density lipoprotein cholesterol, whereas participants with dyslipidemia only showed high total cholesterol and low-density lipoprotein cholesterol throughout. CONCLUSIONS Metabolic biomarkers were affected by blood sample timing and underlying metabolic disease. The Japan Environment and Children's Study will clarify the influences of metabolic status during pregnancy on the health and development of the offspring in future studies.
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Affiliation(s)
- Hatoko Sasaki
- National Center for Child Health and DevelopmentTokyoJapan
- Present address:
Medical Support Center for Japan Environment and Children’s Study (JECS)National Center for Child Health and DevelopmentTokyoJapan
| | - Naoko Arata
- National Center for Child Health and DevelopmentTokyoJapan
| | - Ai Tomotaki
- National Center for Child Health and DevelopmentTokyoJapan
- National Center for Global Health and Medicine/National College of NursingTokyoJapan
| | | | | | - Mizuho Konishi
- National Center for Child Health and DevelopmentTokyoJapan
| | | | | | - Miori Sato
- National Center for Child Health and DevelopmentTokyoJapan
| | | | - Hirohisa Saito
- National Center for Child Health and DevelopmentTokyoJapan
| | - Yukihiro Ohya
- National Center for Child Health and DevelopmentTokyoJapan
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30
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Zhang X, Wei Y, Fan L, Zhao Y, Li Y, Liu Y, Lu J, Ji L, Yang H. A multicenter all-inclusive prospective study on the relationship between glycemic control markers and maternal and neonatal outcomes in pregnant women. J Matern Fetal Neonatal Med 2020; 34:3154-3161. [PMID: 32664766 DOI: 10.1080/14767058.2019.1678139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pregnant women afflicted with gestational diabetes mellitus (GDM) and diabetes mellitus (DM) are prone to both maternal and neonatal complications. Due to this, it is of importance to sustain a strict glycemic control during this time. Unfortunately, there is a lack of evidence-based medical research for the control criteria during pregnancy. Therefore, to develop better method of glycemic control for pregnant women, we conducted a multicenter all-inclusive prospective study to investigate the association between glycemic control markers and maternal and neonatal outcomes.Research design and methods: Four hundred fifty-two women were included in the study. Fasting blood glucose (FBG), HbA1c and glycated albumin (GA), and ferritin levels were measured at different gestational periods and compared to the pregnancy outcomes. RESULTS The reference interval of GA and HbA1c was determined in Trimester I, II, III: 11.0-16.3%, 10.1-15.2%, and 9.5-14.6%, and 4.8-5.7%, 4.4-5.4%, and 4.7-5.8%, respectively. It was found that at the later stages of pregnancy, there was a reduction in ferritin levels and increase in HbA1c levels. Only in the GDM group, it was noticed that the frequency of total neonatal and maternal complications were significantly higher on comparison with the normal group (30.1 vs. 18.4%, p = .017 and 21.0% vs. 12.0%, p = .031, respectively). For the frequency of cesarean section and macrosomia in GDM group, GA > 15.69% group was significant higher compared to those of GA ≤ 15.69% group (p = .021 and p = .001, respectively). For HbA1c, no significant differences were observed. CONCLUSIONS A reference interval of HbA1c and GA was developed for Chinese pregnant women. We found that the GDM group had a higher frequency of neonatal and maternal complications. As only GA levels and not HbA1c, were associated with cesarean section and macrosomia in GDM, we hypothesize that GA could be an appropriate glycemic control marker for pregnant mothers.
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Affiliation(s)
- Xiaoming Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yumei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ling Fan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics, Peking University Third Hospital, Beijing, China
| | - Yufeng Li
- Department of Endocrinology, Beijing Pinggu Hospital, Beijing, China
| | - Yanjun Liu
- Department of Endocrinology, The 306 Hospital of PLA, Beijing, China
| | - Juming Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology, Peking University Peoples Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Bi J, Ji C, Wu Y, Wu M, Liu Y, Song L, Khatiwada SU, Yang S, Li B, Wang Y, Wu L. Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes. J Clin Endocrinol Metab 2020; 105:5804622. [PMID: 32166332 DOI: 10.1210/clinem/dgaa127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/06/2020] [Indexed: 01/25/2023]
Abstract
CONTEXT Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence regarding the association between higher glycated hemoglobin A1c (HbA1c) within the normal range and adverse birth outcomes is limited. OBJECTIVE We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. DESIGN AND SETTING The data were abstracted from the Information System of Guangdong Women and Children Hospital, China, from September 2014 to March 2018. PATIENTS A total of 5658 pregnant women with normal gestational HbA1c were included in this analysis. MAIN OUTCOME MEASURES The adverse birth outcomes include preterm birth, macrosomia, and large for gestational age (LGA). RESULTS Among 5658 subjects, the rates of preterm birth, macrosomia, and LGA were 4.6% (261/5658), 3.5% (200/5658), and 5.7% (325/5658), respectively. The results of multivariate logistic regression model showed that each 1% increase in maternal HbA1c was positively associated with increased risks of preterm birth (OR 1.58; 95% CI, 1.08-2.31), macrosomia (OR 1.70; 95% CI, 1.10-2.64), and LGA (OR 1.38; 95% CI, 0.98-1.96). The association between gestational HbA1c and preterm birth was more evident among women with prepregnancy body mass index (BMI) ≤ 24 kg/m2. CONCLUSIONS Gestational higher HbA1c level within the normal range is an independent risk factor for preterm birth, macrosomia, and LGA. Intervention for reducing HbAc1 may help to prevent adverse birth outcomes.
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Affiliation(s)
- Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cunwei Ji
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yuntao Wu
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Mingyang Wu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yunyun Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shikha Upadhyaya Khatiwada
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Senbei Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bing Li
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Wu
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Sakurai K, Kato T, Tanabe H, Taguchi‐Atarashi N, Sato Y, Eguchi A, Watanabe M, Ohno H, Mori C. Association between gut microbiota composition and glycoalbumin level during pregnancy in Japanese women: Pilot study from Chiba Study of Mother and Child Health. J Diabetes Investig 2020; 11:699-706. [PMID: 31721478 PMCID: PMC7232291 DOI: 10.1111/jdi.13177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/28/2019] [Accepted: 11/09/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS/INTRODUCTION Gut microbiota have various effects on human health. Some previous reports have shown that gut microbiota change during pregnancy and affect metabolism, but others have shown that microbiota do not change. Here, we examined the gut microbiota and glycoalbumin levels of 45 healthy Japanese women during pregnancy. MATERIALS AND METHODS We carried out 16S rRNA gene sequencing analyses of maternal stool samples and compared the gut microbiota composition of samples from women in early and late pregnancy. We also examined the association between gut microbiota and maternal characteristics, including glycoalbumin. RESULTS Microbiota composition in early and late pregnancy did not differ, according to principal coordinate analysis of weighted and unweighted UniFrac distances. Shannon indices were not different between early and late pregnancy. The proportion of one phylum, TM7, significantly decreased in late pregnancy compared with early pregnancy, but the proportions of other major phyla did not change. The Shannon index of late pregnancy was negatively associated with pregestational body mass index and positively correlated with glycoalbumin level, with adjustment of covariates. CONCLUSIONS We concluded that Japanese women did not show obvious differences in gut microbiota during pregnancy, except for TM7, and that the diversity of gut microbiota might affect maternal metabolism. As this study had limited statistical power, further large-scale studies are required.
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Affiliation(s)
- Kenichi Sakurai
- Department of Nutrition and Metabolic MedicineCenter for Preventive Medical SciencesChiba UniversityChibaJapan
| | - Tamotsu Kato
- Laboratory for Intestinal EcosystemRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Hiromi Tanabe
- Department of Nutrition and Metabolic MedicineCenter for Preventive Medical SciencesChiba UniversityChibaJapan
| | - Naoko Taguchi‐Atarashi
- Laboratory for Intestinal EcosystemRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Yumi Sato
- Department of Nutrition and Metabolic MedicineGraduate School of Medical and Pharmaceutical SciencesChiba UniversityChibaJapan
| | - Akifumi Eguchi
- Department of Sustainable Health ScienceCenter for Preventive Medical SciencesChiba UniversityChibaJapan
| | - Masahiro Watanabe
- Department of Sustainable Health ScienceCenter for Preventive Medical SciencesChiba UniversityChibaJapan
| | - Hiroshi Ohno
- Laboratory for Intestinal EcosystemRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Chisato Mori
- Department of Sustainable Health ScienceCenter for Preventive Medical SciencesChiba UniversityChibaJapan
- Department of Bioenvironmental MedicineGraduate School of MedicineChiba UniversityChibaJapan
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Visceral adiposity is associated with the discrepancy between glycated albumin and HbA1c in type 2 diabetes. Diabetol Int 2020; 11:368-375. [PMID: 33088644 DOI: 10.1007/s13340-020-00431-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/05/2020] [Indexed: 01/31/2023]
Abstract
Aim We investigated the association of visceral adiposity with glycated albumin (GA) as well as GA/hemoglobin A1c (HbA1c) in type 2 diabetes. Methods One hundred twenty-three patients (68 males, 55 females) with type 2 diabetes were enrolled in this cross-sectional study. Visceral fat area (VFA) was determined using an abdominal dual bioelectrical impedance analysis (dual BIA) instrument. The relationship of VFA with GA and GA/HbA1c was analyzed. Results Simple regression analysis showed that BMI was inversely correlated with GA as well as GA/HbA1c, but not with HbA1c, while VFA had a significant correlation with GA and GA/HbA1c. Furthermore, multiple regression analysis revealed VFA as an independent contributor to GA/HbA1c. These results suggest that visceral adiposity is a primary factor associated with GA and HbA1c level discrepancy in patients with type 2 diabetes. Conclusions GA is a useful indicator for glycemic control, while visceral obesity should also be taken into consideration in type 2 diabetes cases.
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Dong Y, Zhai Y, Wang J, Chen Y, Xie X, Zhang C, Liu J, Lu Y, Tang G, Han L, Li L, Cao Z. Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes. BMC Pregnancy Childbirth 2020; 20:12. [PMID: 31900124 PMCID: PMC6942295 DOI: 10.1186/s12884-019-2704-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022] Open
Abstract
Background Many efforts have been focused on the alternative glycemic marker glycated albumin (GlyA) and its application in pregnancy during which profound physiological changes take place. Our objective was to determine the reference intervals (RIs) of GlyA in healthy Chinese pregnant women and to assess the predictive value of serum GlyA in adverse pregnancy outcomes. Methods Totally 421 healthy subjects including 137 in the first trimester, 152 in the second trimester, and 132 in the third trimester were enrolled from March to July 2019, for the purpose of establishing the trimester-specific RIs of GlyA. In addition, 67 pregnant women diagnosed with GDM were enrolled at 24–28 weeks of gestation. The diagnostic value of GlyA for GDM patients was evaluated and compared with that of fasting plasma glucose (FPG) at 24–28 weeks of gestation. The association between GlyA in the late pregnancy and the adverse pregnancy outcomes was analyzed with the data collected from January to June 2018 at our hospital. Results The estimated RIs of GlyA in present study were 11.26–15.10%, 10.04–13.50%, and 9.76–13.09% in the first, second, and third trimesters respectively. The areas under receiver operating characteristic (ROC) curves were 0.503 for GlyA and 0.705 for FPG. More importantly, the GlyA level in the third trimester was not more elevated in the patients with adverse pregnancy outcomes including large for gestational age (LGA), preterm delivery, hypertension and preeclampsia (PE). The exception was made with the GDM patients who suffered from postpartum hemorrhage and had significantly higher GlyA levels than the control group. Conclusions Our results showed that the GlyA was continuously decreased as the gestational age went up. The GlyA testing has limited value in diagnosing GDM and predicting adverse pregnancy outcomes.
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Affiliation(s)
- Ying Dong
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Jing Wang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Yi Chen
- Obstetrical Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Xie
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Chunhong Zhang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Jingrui Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Yifan Lu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Guodong Tang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China.,Prenatal Diagnosis Center, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| | - Lican Han
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Lin Li
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China.
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Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Eldem S, Hancerliogullari N, Engin-Ustun Y. Maternal serum glycosylated hemoglobin and fasting plasma glucose predicts gestational diabetes at the first trimester in Turkish women with a low-risk pregnancy and its relationship with fetal birth weight; a retrospective cohort study. J Matern Fetal Neonatal Med 2019; 34:1970-1977. [PMID: 31370710 DOI: 10.1080/14767058.2019.1651837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the accuracy of maternal serum glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in predicting gestational diabetes at the first trimester in Turkish women with a low-risk pregnancy and its relationship with fetal birth weight. METHODS This cohort study was conducted retrospectively in a tertiary referral hospital from January 2010 to January 2017. HbA1c and FPG serum concentrations were measured in 670 pregnant women at the first-trimester screening. HbA1c and FPG concentrations of women who subsequently developed gestational diabetes mellitus (GDM) were compared to those who did not, and its relationship with fetal weight was investigated. RESULTS First-trimester screening was performed on 608 pregnant women, of whom 69 (11.3%) women had developed GDM. Median HbA1c and FPG concentrations were significantly higher in women developing GDM (n = 69) in comparison to those with uncomplicated pregnancies (n = 539) (5.31 ± 0.58% versus 5.01 ± 0.45%, p < .001 and 89.74 ± 8.71% versus 84.09 ± 9.16%, p < .001, respectively). The cut-off value calculated with the highest Youden index was HbA1c levels above 5.6% with a sensitivity of 34.78%, specificity of 89.8%, with a diagnostic accuracy of 83.55%, and FPG levels above 86.85 mg/dl with a sensitivity of 69.57%, specificity of 61.78%, with a diagnostic accuracy of 62.66%. The calculated odds ratio (OR) for HbA1c > 5.6% and FPG > 86 mg/dl were 4.69 (95% CI: 2.66-8.29), and 3.7 (95% CI: 2.15-6.35), respectively. HbA1c and FPG combined had improved the predictive capability for GDM (OR: 7.26, 95% CI: 3.71-14.19). According to correlation analyses, a noteworthy positive correlation was found between HbA1c and, FPG, 50 g GCT, age, BMI, parity, and birth weight. However, there was no correlation between FPG and birth weight. CONCLUSION Diagnostic accuracy of HbA1c for GDM prediction in Turkish women with a low-risk pregnancy is 83.55% with a very good negative predictive value of 91.49%. HbA1c and FPG combined enhanced the predictive capability for GDM. In addition, there is a positive relationship between HbA1c and 50 g GCT, and birth weight. However, to suggest HbA1c as a potential screening test for gestational diabetes mellitus, further research is warranted.
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Affiliation(s)
- Hatice Kansu-Celik
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Burcu Kisa
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sinem Eldem
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Necati Hancerliogullari
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Yu H, Wang J, Shrestha Y, Hu Y, Ma Y, Ren L, Zhang J, Li J. Importance of early elevated maternal HbA1c levels in identifying adverse fetal and neonatal events. Placenta 2019; 86:28-34. [PMID: 31401007 DOI: 10.1016/j.placenta.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/12/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Abstract
AIMS The aims of this study were to explore factors that associated with gestational diabetes mellitus (GDM), and to determine the relationship between early maternal HbA1c levels and adverse fetal or neonatal events, and to determine an optimal maternal glucose testing method in order to decrease the potential health risk for their offspring. METHODS From December 2015 to May 2016, a total of 6744 pregnant women were enrolled from Shanghai First Maternal and Infant Hospital affiliated to Tongji University prospectively in the nested case-control study. Each GDM case was matched with a healthy pregnant woman and followed up. Outcome analyses were conducted between GDM case and control groups, as well as elevated and normal maternal HbA1c levels, respectively. RESULTS A total of 1836 women were included in the adverse fetal and neonatal events examination. For pregnant women with early HbA1c ≥ 5.2%, the adjusted risk ratios (RR) of respiratory distress syndrome (RDS), pneumonia and jaundice were 4.37 (95%CI 1.54-12.35), 2.03 (95%CI 1.24-3.33) and 1.49 (95%CI 1.01-2.20), respectively. After treatments, the frequency for the majority of events in GDM group was similar to that of healthy pregnant women. Moreover, the area under the curve (AUC) of early maternal HbA1c in predicting potential RDS is 0.734. HbA1c ≤ 4.9% excluded for RDS. CONCLUSIONS Compared with women with normal HbA1c, those with an early elevated HbA1c level were more likely to develop adverse events, including RDS, pneumonia and jaundice. Early HbA1c testing can be used as an auxiliary method identifying potential RDS.
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Affiliation(s)
- Han Yu
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Key Laboratory of Arrhythmias, Ministry of Education, China, Tongji University School of Medicine, China.
| | - Jing Wang
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Department of Gynecology and Obstetrics, Shanghai Tongji Hospital Affiliated to Tongji University School of Medicine, China
| | - Yeshaswi Shrestha
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Key Laboratory of Arrhythmias, Ministry of Education, China, Tongji University School of Medicine, China
| | - Yongjia Hu
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Key Laboratory of Arrhythmias, Ministry of Education, China, Tongji University School of Medicine, China
| | - Yuan Ma
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Key Laboratory of Arrhythmias, Ministry of Education, China, Tongji University School of Medicine, China
| | - Longbing Ren
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Key Laboratory of Arrhythmias, Ministry of Education, China, Tongji University School of Medicine, China
| | - Jun Zhang
- Department of Clinical Laboratory, Shanghai First Maternity and Infant Hospital Affiliated to Tongji University School of Medicine, China
| | - Jue Li
- Institute of Clinical Epidemiology and Evidence-based Medicine, Tongji University School of Medicine, China; Key Laboratory of Arrhythmias, Ministry of Education, China, Tongji University School of Medicine, China.
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Mendes N, Alves M, Andrade R, Ribeiro RT, Papoila AL, Serrano F. Association between glycated albumin, fructosamine, and HbA1c with neonatal outcomes in a prospective cohort of women with gestational diabetes mellitus. Int J Gynaecol Obstet 2019; 146:326-332. [PMID: 31242319 DOI: 10.1002/ijgo.12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/23/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). METHODS Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. RESULTS A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. CONCLUSION Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.
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Affiliation(s)
- Neuza Mendes
- Department of Maternal-Fetal Medicine, Central Lisbon Hospital Center, Lisbon, Portugal.,NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Marta Alves
- Epidemiology and Statistics Unit, Research Center, Central Lisbon Hospital Center, Lisbon, Portugal.,CEAUL (Center of Statistics and its Applications), University of Lisbon, Lisbon, Portugal
| | - Rita Andrade
- Education and Research Center (APDP-ERC), Portuguese Diabetes Association, Lisbon, Portugal.,CEDOC Chronic Diseases - NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rogério T Ribeiro
- Education and Research Center (APDP-ERC), Portuguese Diabetes Association, Lisbon, Portugal.,CEDOC Chronic Diseases - NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,UA-DCM - Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Luísa Papoila
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Epidemiology and Statistics Unit, Research Center, Central Lisbon Hospital Center, Lisbon, Portugal.,CEAUL (Center of Statistics and its Applications), University of Lisbon, Lisbon, Portugal
| | - Fátima Serrano
- Department of Maternal-Fetal Medicine, Central Lisbon Hospital Center, Lisbon, Portugal.,NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Yasuda S, Iuchi T, Goto A, Katanoda K, Iida S, Oikawa Y, Namba A, Isshiki M, Inoue I, Kamei Y, Shimada A, Noda M. Weight control before and during pregnancy for patients with gestational diabetes mellitus. J Diabetes Investig 2019; 10:1075-1082. [PMID: 30548799 PMCID: PMC6626955 DOI: 10.1111/jdi.12989] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/29/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION The aim of the present study was to examine the associations of pregestational body mass index (BMI) and gestational weight change with birthweight for gestational age in Japanese mothers with gestational diabetes mellitus (GDM). MATERIALS AND METHODS We retrospectively examined the clinical and laboratory characteristics of 101 mothers with GDM (pregestational BMI 24.7 ± 5.8 kg/m2 ; maternal age at delivery 34.7 ± 5.1 years; gestational age 38.5 ± 1.4 weeks) at a single center from January 2011 to December 2016. RESULTS Gestational weight changes were 6.22 ± 5.39 kg, and infant birthweights were 2,987.3 ± 393.6 g. Multivariable analysis showed that, in all mothers, pregestational BMI and gestational weight change were positively associated with infant birthweight (P < 0.001 and P = 0.007, respectively). Pregestational BMI, but not gestational weight change, was positively associated with infant birthweight (P = 0.007) in 31 mothers with GDM who had pregestational BMI ≥25 kg/m2 ; in 68 mothers with GDM who had pregestational BMI 18.5-24.9 kg/m2 , only gestational weight gain was positively associated with infant birthweight (P = 0.039). Two mothers had pregestational BMI <18.5 kg/m2 . No statistically significant interactions of pregestational BMI with gestational weight change were found (P = 0.158). CONCLUSIONS In mothers with GDM, pregestational BMI ≥25 kg/m2 and excessive gestational weight gain were significantly associated with increased infant birthweight. A prospective multicenter clinical study enrolling a larger number of mothers with GDM will be required to verify the effects of adequately controlling pregestational and gestational weights on infant birthweight for gestational age.
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Affiliation(s)
- Shigemitsu Yasuda
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Takujiro Iuchi
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Atsushi Goto
- Epidemiology and Prevention GroupCenter for Public Health SciencesNational Cancer CenterTokyoJapan
| | - Kota Katanoda
- Division of Cancer Statistics IntegrationCenter for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | - Shinichiro Iida
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Yoichi Oikawa
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Akira Namba
- Department of Obstetrics and GynecologySaitama Medical University HospitalJapan
| | - Masashi Isshiki
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Ikuo Inoue
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Yoshimasa Kamei
- Department of Obstetrics and GynecologySaitama Medical University HospitalJapan
| | - Akira Shimada
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
| | - Mitsuhiko Noda
- Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
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Arbib N, Shmueli A, Salman L, Krispin E, Toledano Y, Hadar E. First trimester glycosylated hemoglobin as a predictor of gestational diabetes mellitus. Int J Gynaecol Obstet 2019; 145:158-163. [DOI: 10.1002/ijgo.12794] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/27/2018] [Accepted: 02/19/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Nissim Arbib
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Department of Obstetrics & GynecologyMeir Medical Center Kfar‐Saba Israel
| | - Anat Shmueli
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Lina Salman
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Eyal Krispin
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Yoel Toledano
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Eran Hadar
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
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Dubey D, Kunwar S, Gupta U. Mid‐trimester glycosylated hemoglobin levels (HbA1c) and its correlation with oral glucose tolerance test (World Health Organization 1999). J Obstet Gynaecol Res 2019; 45:817-823. [DOI: 10.1111/jog.13916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 12/08/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Devanshi Dubey
- Department of Obstetrics and GynaecologyEra's Lucknow Medical College and Hospital Lucknow India
| | - Shipra Kunwar
- Department of Obstetrics and GynaecologyEra's Lucknow Medical College and Hospital Lucknow India
| | - Uma Gupta
- Department of Obstetrics and GynaecologyMayo Institute of Medical Sciences Lucknow India
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Zhang X, Xiao Y, Fan Y. Investigating the Reliability of HbA1c Monitoring for Blood Glucose Control During Late Pregnancy in Patients with Gestational Diabetes Mellitus (GDM) with and without β-Thalassemia Minor. Diabetes Ther 2018; 9:2305-2313. [PMID: 30284689 PMCID: PMC6250624 DOI: 10.1007/s13300-018-0516-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Patients with gestational diabetes mellitus (GDM) need strict blood glucose control to reduce the incidence of perinatal complications in the mother or infant. The purpose of this study was to investigate whether the glycated hemoglobin (HbA1c) values of GDM patients were affected by β-thalassemia minor and to subsequently discuss the limitations of HbA1c monitoring for blood glucose control. METHODS 41 GDM patients with β-thalassemia minor were enrolled to serve as the study group. 93 GDM patients without thalassemia were randomly selected as a control group. Clinical data on the 134 mothers as well as their newborns were retrospectively analyzed. The blood glucose values of the participants at various times during the gestation period were compared between the groups, as were their HbA1c and ferritin levels and iron deficiency rates in late pregnancy (36-38 weeks of gestation). Pearson's coefficient was calculated to determine the correlations between HbA1c and ferritin in both the study and control groups. RESULTS The study and control groups did not show any significant differences in newborn birth weight, maternal age, maternal pre-pregnancy body mass index (BMI), gestational age, newborn sex, gravidity, and parity. The blood glucose values of the participants at different times during the gestation period also did not differ significantly between the study group and the control group. However, the late-pregnancy HbA1c level (5.23 ± 0.49%) and iron deficiency rate (12.19%) in the study group were significantly lower than those in the control group (5.42 ± 0.43% and 58.06%, respectively); P < 0.05. Also, the late-pregnancy ferritin level in the study group (46.59 ± 18.03 ng/mL) was significantly higher than that in the control group (25.58 ± 11.42 ng/mL); P < 0.05. In addition, a significant negative correlation was observed between HbA1c and ferritin in both the study group (R = - 0.459, P = 0.003) and the control group (R = - 0.358, P = 0.010). CONCLUSIONS The HbA1c level is affected by many factors. Using serum HbA1c values to monitor blood glucose in GDM patients with β-thalassemia minor may lead to a mistaken assumption of low blood glucose levels, so HbA1c may not be a suitable indicator for monitoring blood glucose in pregnant women, particularly GDM patients with β-thalassemia minor.
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Affiliation(s)
- Xueqin Zhang
- Department of Obstetrics, Maternal and Child Healthcare Hospital of Xiamen City, Xiamen, Fujian, China
| | - Yunshan Xiao
- Department of Obstetrics, Maternal and Child Healthcare Hospital of Xiamen City, Xiamen, Fujian, China.
| | - Yanfeng Fan
- Department of Obstetrics, Maternal and Child Healthcare Hospital of Xiamen City, Xiamen, Fujian, China
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Teasdale S, Morton A. Changes in biochemical tests in pregnancy and their clinical significance. Obstet Med 2018; 11:160-170. [PMID: 30574177 PMCID: PMC6295771 DOI: 10.1177/1753495x18766170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/22/2018] [Indexed: 12/11/2022] Open
Abstract
Interpretation of laboratory investigations relies on reference intervals. Physiological changes in pregnancy may result in significant changes in normal values for many biochemical assays, and as such results may be misinterpreted as abnormal or mask a pathological state. The aims of this review are as follows: 1. To review the major physiological changes in biochemical tests in normal pregnancy. 2. To outline where these physiological changes are important in interpreting laboratory investigations in pregnancy. 3. To document the most common causes of abnormalities in biochemical tests in pregnancy, as well as important pregnancy-specific causes.
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Affiliation(s)
- Stephanie Teasdale
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
| | - Adam Morton
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
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Poo ZX, Wright A, Ruochen D, Singh R. Optimal first trimester HbA1c threshold to identify Singaporean women at risk of gestational diabetes mellitus and adverse pregnancy outcomes: A pilot study. Obstet Med 2018; 12:79-84. [PMID: 31217812 DOI: 10.1177/1753495x18795984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/27/2018] [Indexed: 01/26/2023] Open
Abstract
This pilot study examined the use of early HbA1c in screening for gestational diabetes mellitus and adverse pregnancy outcomes in Singapore. One hundred and fifty-one pregnant women with a gestational age of under 14 weeks had an HbA1c test measured with their antenatal bloods prior to a second trimester oral glucose tolerance test. Patient characteristics and pregnancy outcome data were collected. Gestational diabetes mellitus prevalence was 11%. A receiver operating characteristic curve showed an HbA1c level of 5.2% (33 mmol/mol), had an 82% sensitivity, 72% specificity, 97% negative predictive value and 27% positive predictive value to predict gestational diabetes mellitus. Women with HbA1c of 5.2% (33 mmol/mol) or over 5.2% (33 mmol/mol) were older, had higher BMI and were less likely to be Chinese than those with HbA1c less than 5.2% (33 mmol/mol). There was no difference in pregnancy outcomes. Early HbA1c less than 5.2% (33 mmol/mol) may be useful to exclude low-risk Singaporean women from further testing, while those with HbA1c of 5.2% (33 mmol/mol) or greater would still need a oral glucose tolerance test between 24 and 28 weeks' gestation.
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Affiliation(s)
- Zi X Poo
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ann Wright
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Du Ruochen
- KK Women's and Children's Hospital, Singapore, Singapore
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Sánchez-González CM, Castillo-Mora A, Alvarado-Maldonado IN, Ortega-González C, Martínez-Cruz N, Arce-Sánchez L, Ramos-Valencia M, Molina-Hernández A, Estrada-Gutierrez G, Sosa SEY, Recio-López Y, Hernández-Sánchez R, Reyes-Muñoz E. Reference intervals for hemoglobin A1c (HbA1c) in healthy Mexican pregnant women: a cross-sectional study. BMC Pregnancy Childbirth 2018; 18:424. [PMID: 30373541 PMCID: PMC6206911 DOI: 10.1186/s12884-018-2057-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 10/15/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The reference intervals for hemoglobin A1c (HbA1c) in pregnant Mexican women without diabetes are not well defined. The study aims to determine the reference intervals for HbA1c at each trimester in healthy Mexican pregnant women. METHODS This cross-sectional study included healthy Mexican pregnant women in trimester 1 (T1), 6-13.6 weeks of gestation (WG), trimester 2 (T2), 14-27 WG, and trimester 3 (T3), ≥27-36 WG, with a maternal age > 18 years, and pregestational body mass index (BMI) ranging between 18.5-24.9 kg/m2. Women with gestational diabetes mellitus, pregestational diabetes, anemia, a pregestational BMI < 18.5 or ≥ 25 kg/m2, and any hematologic, hepatic, immunological, renal, or cardiac disease were excluded. HbA1c was measured using high-performance liquid chromatography based on the National Glycohemoglobin Standardization Program-certified PDQ Primus guidelines. The HbA1c reference intervals were calculated in terms of the 2.5th to the 97.5th percentiles. RESULTS We analyzed the HbA1c values of 725 women (T1 n = 84, T2 n = 448, and T3 n = 193). The characteristics of the participants were expressed as mean ± standard deviation and included: maternal age (28.2 ± 6.7 years), pregestational weight (54.8 ± 5.9 Kg), pregestational BMI (22.2 ± 1.7 Kg/m2), and glucose values using a 75 g-2 h oral glucose tolerance test; fasting 4.5 ± 0.3 mmol/L (81.5 ± 5.5 mg/dL), 1 h 6.4 ± 1.5 mmol/L (115.3 ± 26.6 mg/dL), and 2 h 5.7 ± 1.1 mmol/L (103.5 ± 19.6 mg/dL). Reference intervals for HbA1c, expressed as median and 2.5th to 97.5th percentile for each trimester were: T1: 5.1 (4.5-5.6%), T2: 5.0 (4.4-5.5%), and T3: 5.1 (4.5-5.6%). CONCLUSIONS The reference range of HbA1C in healthy Mexican pregnant women during pregnancy was 4.4% to 5.6%. We suggest as upper limits of HbA1c value ≤5.6%, 5.5%, and 5.7% for T1, T2, and T3, respectively among Mexican pregnant women.
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Affiliation(s)
- Cristina M Sánchez-González
- Division of Reproductive Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Programa de Maestría en Ciencias Médicas de la Universidad Anáhuac Norte, Mexico City, Mexico
| | - Alfredo Castillo-Mora
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Itzel N Alvarado-Maldonado
- Division of Reproductive Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Carlos Ortega-González
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Nayeli Martínez-Cruz
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Lidia Arce-Sánchez
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Mabel Ramos-Valencia
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Anayansi Molina-Hernández
- Departament of Physiology and Cellular Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutierrez
- Direction of Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Salvador Espino Y Sosa
- Division of Clinical Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Yesenia Recio-López
- Division of Reproductive Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Programa de Maestría en Ciencias Médicas de la Universidad Anáhuac Norte, Mexico City, Mexico
| | - Ruth Hernández-Sánchez
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas Virreyes, Miguel Hidalgo, CP 11000, Mexico City, DF, Mexico
| | - Enrique Reyes-Muñoz
- Division of Obstetrics and Gynecology, Hospital Regional Universitario de Colima, Colima, Mexico.
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Hinkle SN, Tsai MY, Rawal S, Albert PS, Zhang C. HbA 1c Measured in the First Trimester of Pregnancy and the Association with Gestational Diabetes. Sci Rep 2018; 8:12249. [PMID: 30116010 PMCID: PMC6095876 DOI: 10.1038/s41598-018-30833-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022] Open
Abstract
We aimed to examine the prospective association between first trimester HbA1c and gestational diabetes (GDM) and explore the utility of HbA1c for prediction of GDM. We used data from a case-control study within the prospective NICHD Fetal Growth Studies-Singleton Cohort (2009-2013), which enrolled 2,802 women at 12 U.S. clinical centers. HbA1c was measured in GDM cases (n = 107) and matched controls (n = 214) targeted at 8-13, 16-22, 24-29, and 34-37 gestational weeks. We excluded women with HbA1c ≥ 6.5% (48 mmol/mol) at enrollment (n = 3) or who had a hemoglobin variant (n = 6). At 8-13 gestational weeks, women who later developed GDM had significantly higher HbA1c (5.3[standard deviation 0.3]%; 34[4]mmol/mol) than women without GDM (5.1[0.3]%; 32[3] mmol/mol) (P ≤ 0.001); this difference remained significant throughout pregnancy. Each 0.1% (1 mmol/mol) HbA1c increase at 8-13 weeks was associated with an adjusted 22% increased GDM risk (95% confidence interval 1.09-1.36). First trimester HbA1c significantly improved GDM prediction over conventional risk factors (AUC 0.59 vs 0.65; P = 0.04). In conclusion, women who develop GDM may have impaired glucose homeostasis early in or prior to pregnancy, as indicated by their elevated first trimester HbA1c. First trimester HbA1c may aid in early identification of at risk women.
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Affiliation(s)
- Stefanie N Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Eto E, Maki J, Tamada S, Mitsui T, Hayata K, Hiramatsu Y, Masuyama H. Assessment of resting energy expenditure and body composition in Japanese pregnant women with diabetes. J Diabetes Investig 2018; 9:959-966. [PMID: 29280333 PMCID: PMC6031507 DOI: 10.1111/jdi.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION To measure longitudinal changes in resting energy expenditure and body composition of Japanese pregnant women with or without diabetes. MATERIALS AND METHODS The study population consisted of women who had delivered a live singleton neonate after 22 weeks' gestation at Okayama University Hospital from July 2013 to June 2017. Resting energy expenditure and body composition were measured in the first trimester, second trimester, third trimester and postpartum. RESULTS A total of 144 women participated in this study: 103 with normal glucose tolerance and 41 with diabetes. The resting energy expenditure (kcal/day) of pregnant women with normal glucose tolerance was significantly higher in the third trimester (1,644 ± 234) than in the first (1,461 ± 215) and second trimesters (1,491 ± 219), and postpartum (1,419 ± 254), whereas that of pregnant women with diabetes did not significantly change during all periods (1,568 ± 404, 1,710 ± 332, 1,716 ± 251, 1,567 ± 249). The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Fat-free mass was closely correlated with resting energy expenditure. CONCLUSIONS The resting energy expenditure of Japanese pregnant women with normal glucose tolerance was significantly increased in the third trimester. The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Resting energy expenditure and fat-free mass are potential indexes for medical nutrition therapy in pregnant women with diabetes.
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Affiliation(s)
- Eriko Eto
- Department of Obstetrics and GynecologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Jota Maki
- Department of Obstetrics and GynecologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Shoko Tamada
- Department of Obstetrics and GynecologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Takashi Mitsui
- Department of Obstetrics and GynecologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Kei Hayata
- Department of Obstetrics and GynecologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Yuji Hiramatsu
- Department of Obstetrics and GynecologyOkayama City General Medical CenterOkayamaJapan
| | - Hisashi Masuyama
- Department of Obstetrics and GynecologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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Raghav A, Ahmad J. Glycated albumin in chronic kidney disease: Pathophysiologic connections. Diabetes Metab Syndr 2018; 12:463-468. [PMID: 29396251 DOI: 10.1016/j.dsx.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
Nephropathy in diabetes patients is the most common etiology of end-stage kidney disease (ESKD). Strict glycemic control reduces the development and progression of diabetes-related complications, and there is evidence that improved metabolic control improves outcomes in subjects having diabetes mellitus with advanced chronic kidney disease (CKD). Glycemic control in people with kidney disease is complex. Changes in glucose and insulin homoeostasis may occur as a consequence of loss of kidney function and dialysis. The reliability of measures of long-term glycemic control is affected by CKD and the accuracy of glycated haemoglobin (HbA1c) in the setting of CKD and ESKD is questioned. Despite the altered character of diabetes in CKD, current guidelines for diabetes management are not specifically adjusted for this patient group. The validity of indicators of long-term glycemic control has been the focus of increased recent research. This review discusses the current understanding of commonly used indicators of metabolic control (HbA1c, fructosamine, glycated albumin) in the setting of advanced CKD.
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Affiliation(s)
- Alok Raghav
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, India
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes & Endocrinology, J.N Medical College, Aligarh Muslim University, Aligarh, 202002, India.
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Mendes N, Tavares Ribeiro R, Serrano F. Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus. J OBSTET GYNAECOL 2018; 38:762-769. [PMID: 29620435 DOI: 10.1080/01443615.2017.1412409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.
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Affiliation(s)
- Neuza Mendes
- a Department of Maternal-Fetal Medicine , Maternidade Dr. Alfredo da Costa, Central Lisbon Hospital Center , Lisbon , Portugal.,b NOVA Medical School , Universidade NOVA de Lisboa , Lisbon , Portugal
| | - Rogério Tavares Ribeiro
- c Education and Research Center (APDP-ERC) , Portuguese Diabetes Association , Lisboa , Portugal.,d CEDOC Chronic Diseases , NOVA Medical School , Lisbon , Portugal
| | - Fátima Serrano
- a Department of Maternal-Fetal Medicine , Maternidade Dr. Alfredo da Costa, Central Lisbon Hospital Center , Lisbon , Portugal.,b NOVA Medical School , Universidade NOVA de Lisboa , Lisbon , Portugal
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Shimizu I, Hiramatsu Y, Omori Y, Nakabayashi M. Comparison of HbA1c and glycated albumin as a control marker for newborn complications in diabetic women in a multicentre study in Japan (Japan glycated albumin study group: study 2). Ann Clin Biochem 2018; 55:639-646. [DOI: 10.1177/0004563218763695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To clarify the relationship between glycated haemoglobin and glycated albumin concentrations during pregnancy with neonatal outcomes, a multicentre study was conducted by the Japanese Society of Diabetes and Pregnancy. Methods A total of 136 patients (type 1: n = 47, type 2: n = 89) who enrolled in the study were diagnosed based on the Japanese Diabetes Society diagnostic criteria for diabetes mellitus. Thresholds for glycated haemoglobin and glycated albumin were set at 5.8% and 15.8%, respectively, as the upper limits of the reference interval in pregnant women. Result Random plasma glucose decreased linearly, and reached the reference interval at 40 weeks. Glycated albumin concentrations also decreased in the same manner. But glycated haemoglobin concentrations were out of the reference interval during the study. The frequency of the neonatal complications did not show significant differences between the glycated haemoglobin ⩾5.8% group and the glycated haemoglobin <5.8% group. On the other hand, the frequency of neonatal complications showed higher tendency of neonatal complications in the incidence of polycythaemia ( P = 0.094) and heavy-for-date ( P = 0.071) in the glycated albumin ⩾15.8% group compared with the glycated albumin <15.8 group. The respiratory disorder in type 1 diabetes was significantly higher than type 2 diabetes. Conclusions For the treatment of pregnant women with diabetes, glycated albumin would be a better marker than glycated haemoglobin. However, glycated albumin is also affected by obesity and albumin, and it is desirable to make a comprehensive judgment with glycated haemoglobin, random plasma glucose and other glycaemic index.
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Affiliation(s)
- Ikki Shimizu
- Department of Diabetes, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics & Gynecology, Okayama University Graduate School, Okayama, Japan
| | - Yasue Omori
- Diabetes Center, Ebina General Hospital, Kanagawa, Japan
| | - Masao Nakabayashi
- Aiiku Maternal and Child Health Center, Imperial Gift Foundation, Tokyo, Japan
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Influence of Iron Deficiency on HbA1c Levels in Pregnant Women: Comparison with Non-Pregnant Women. J Clin Med 2018; 7:jcm7020034. [PMID: 29461483 PMCID: PMC5852450 DOI: 10.3390/jcm7020034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/05/2018] [Accepted: 02/18/2018] [Indexed: 12/19/2022] Open
Abstract
Although HbA1c is widely used as a glycemic control indicator, HbA1c is known to show falsely high levels in patients in an iron deficient state (IDS). We compared the influence of IDS on HbA1c levels between pregnant women, due to mainly an increase in demand for iron without bleeding, and non-pregnant women, due to mainly bleeding (menstruation). We studied 42 non-diabetic pregnant women (pregnant group) and 42 age-matched non-pregnant women with normal glucose tolerance (non-pregnant group). We compared HbA1c and glycated albumin (GA) levels between IDS and normal iron state (NIS) in both groups. Furthermore, we analyzed the correlation between indicators of glycemic control and iron-related parameters [mean corpuscular hemoglobin, serum transferrin saturation (%Tf), and serum ferritin] in both groups. Compared with non-pregnant women, pregnant women had significantly lower %Tf and serum ferritin levels and significantly higher morbidity of IDS. HbA1c, but not GA, had significantly higher levels in pregnant women with IDS compared with NIS; however, HbA1c in non-pregnant women showed no significant difference for both IDS and NIS. In pregnant women, significant negative correlations were observed between HbA1c and iron-related parameters. In non-pregnant women, negative correlations were observed between HbA1c and these parameters, but they were not significant. No significant correlations were observed between GA and iron-related parameters in both groups. HbA1c levels in pregnant women were found to be largely affected by iron deficiency compared with non-pregnant women. For this reason, GA, which is not affected by iron deficiency, is desirable for use in the assessment of glycemic control during pregnancy.
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