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Nisar MI, das S, Khanam R, Khalid J, Chetia S, Hasan T, Shahid S, Marijani ML, Ahmed S, Khalid F, Ali SM, Chowdhury NH, Mehmood U, Dutta A, Rahman S, Qazi MF, Deb S, Mitra DK, Usmani AA, Dhingra U, Raqib R, Manu A, Yoshida S, Minckas N, Bahl R, Baqui AH, Sazawal S, Jehan F. Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa. BMC Pregnancy Childbirth 2024; 24:66. [PMID: 38225559 PMCID: PMC10789021 DOI: 10.1186/s12884-023-06241-w] [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: 08/15/2023] [Accepted: 12/31/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Hyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa. METHODS We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2-3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders. RESULTS A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8-6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9-10.6). CONCLUSION Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.
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Affiliation(s)
- Muhammad Imran Nisar
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sayan das
- Center for Public Health Kinetics, New Delhi, India
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, Baltimore, USA
| | - Javairia Khalid
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | - Tarik Hasan
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Shahira Shahid
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | | | - Farah Khalid
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | | | - Usma Mehmood
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Arup Dutta
- Center for Public Health Kinetics, New Delhi, India
| | - Sayedur Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Muhammad Farrukh Qazi
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Saikat Deb
- Center for Public Health Kinetics, New Delhi, India
- Public Health Laboratory-IDC, Pemba, Tanzania
| | - Dipak Kumar Mitra
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | - Asra Abeer Usmani
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Usha Dhingra
- Center for Public Health Kinetics, New Delhi, India
| | - Rubhana Raqib
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Alexander Manu
- London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Sachiyo Yoshida
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland.
| | - Nicole Minckas
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland
| | - Rajiv Bahl
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, Baltimore, USA
| | | | - Fyezah Jehan
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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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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3
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Isabel C, Faro Rebecca V, Vrijkotte TGM, Theodorus Bartholomeus T. Early pregnancy triglycerides and not fructosamine are associated with birth weight (with foetal sexual dimorphism). Eur J Clin Invest 2023; 53:e13896. [PMID: 36327143 DOI: 10.1111/eci.13896] [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: 06/09/2022] [Revised: 09/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND We evaluated whether maternal triglycerides (TGs) or fructosamine (measured in early pregnancy) predominantly contribute to birth weight (BW), in a foetal sexual dimorphism. METHODS Analysis of data from the Amsterdam Born Children and their Development cohort study (total n = 3514). Maternal nonfasting TGs and fructosamine were determined in early gestation (median 13 weeks). Multivariable linear regression analysis was used to determine whether maternal TGs or fructosamine was associated with BW-small for gestational age (SGA)-large for gestational age (LGA) and whether it was sex-dependent. RESULTS With each 1 mmol/L increase in TGs, BW increased significantly by 81.7 g. This increase was larger with boys (107.3 g; 95% CI 66-148) than girls (60.5 g; 95% CI 23.6-97.4). No association was found with fructosamine. When including different covariates (gestational age at blood sampling, total duration of pregnancy, maternal height, age, parity, ethnicity, educational level, smoking, alcohol, and pre-pregnancy BMI), 29% of the variance in BW can be explained. Adding fructosamine to this model gave no added value in predicting BW, in contrast to adding TGs (R2 raised from 0.292 to 0.299, p < .001). The odds of a newborn LGA with higher maternal TG were increased (OR 1.6, 95% CI 1.3-2.0), in contrast to fructosamine. CONCLUSIONS Maternal TGs were more dominant (compared to fructosamine) in its association with BW (measured in early physiological pregnancy) and more prominently present when carrying a male foetus. These remarkable observations warrant more future research, especially in obese patients at risk for gestational diabetes.
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Affiliation(s)
- Clinck Isabel
- Department of Endocrinology, Diabetology and Metabolism, AZ Monica, Antwerp, Belgium.,Internal Medicine, University of Antwerp, Antwerp, Belgium
| | - Verelst Faro Rebecca
- Department of Endocrinology, Diabetology and Metabolism, AZ Monica, Antwerp, Belgium.,Internal Medicine, University of Antwerp, Antwerp, Belgium
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Twickler Theodorus Bartholomeus
- Department of Endocrinology, Diabetology and Metabolism, AZ Monica, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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4
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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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5
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Immanuel J, Simmons D, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Lapolla A, Dalfra MG, Bertolotto A, Harreiter J, Wender-Ozegowska E, Zawiejska A, Dunne FP, Damm P, Mathiesen ER, Jensen DM, Andersen LLT, Hill DJ, Jelsma JGM, Snoek FJ, Scharnagl H, Galjaard S, Kautzky-Willer A, VAN Poppel MNM. Performance of early pregnancy HbA 1c for predicting gestational diabetes mellitus and adverse pregnancy outcomes in obese European women. Diabetes Res Clin Pract 2020; 168:108378. [PMID: 32828833 DOI: 10.1016/j.diabres.2020.108378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
AIMS To investigate the performance of early pregnancy HbA1c for predicting gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in obese women. METHODS Post hoc analysis using data from the Vitamin D And Lifestyle Intervention for GDM prevention trials conducted across 9 European countries (2012-2014). Pregnant women (BMI ≥ 29 kg/m2) underwent a baseline HbA1c and oral glucose tolerance tests at < 20 weeks, 24-28 weeks, and 35-37 weeks. Women with GDM were referred for treatment. RESULTS Among the 869 women tested, the prevalence of GDM was 25.9% before 20 weeks, with a further 8.6% at 24-28 weeks. The areas under the curves for HbA1c at the two time points were 0.55 (0.50-0.59) and 0.54 (0.47-0.61), respectively. An early HbA1c ≥ 5.7% (39 mmol/mol) (N = 111) showed low sensitivity (18.2%) with 89.1% specificity for GDM before 20 weeks, at 24-28 weeks (sensitivity of 8.0% and specificity of 88.6% after excluding early GDM), and throughout gestation (sensitivity of 15.9% and specificity of 89.4%). The ≥ 5.7% (39 mmol/mol) threshold was significantly associated with concurrent GDM before 20 weeks (adjusted OR (aOR) 2.77(1.39-5.51)) and throughout gestation (aOR 1.72 (1.02-2.89)), but not adverse pregnancy outcomes. CONCLUSIONS Early pregnancy HbA1c is of limited use for predicting either GDM or adverse outcomes in overweight/obese European women.
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Affiliation(s)
- Jincy Immanuel
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, Australia; Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, England, UK.
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - Rosa Corcoy
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Recerca de ĺHospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan M Adelantado
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Belgium; Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
| | | | | | | | - Jürgen Harreiter
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit Medical University of Vienna, Vienna, Austria
| | | | | | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lise Lotte T Andersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - David J Hill
- Recherche en Santé Lawson SA, St. Gallen, Switzerland; Lawson Health Research Institute, London, Ontario, Canada
| | - Judith G M Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Frank J Snoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Hubert Scharnagl
- Medical University of Graz, Clinical Inst Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Belgium; Gynaecology and Obstetrics, University Hospitals Leuven, Belgium; Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Alexandra Kautzky-Willer
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit Medical University of Vienna, Vienna, Austria; Gender Institute Gars am Kamp, Vienna, Austria
| | - Mireille N M VAN Poppel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Institute of Sport Science, University of Graz, Graz, Austria
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Mañé L, Flores-Le Roux JA, Gómez N, Chillarón JJ, Llauradó G, Gortazar L, Payà A, Pedro-Botet J, Benaiges D. Association of first-trimester HbA1c levels with adverse pregnancy outcomes in different ethnic groups. Diabetes Res Clin Pract 2019; 150:202-210. [PMID: 30880095 DOI: 10.1016/j.diabres.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/16/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
AIM To determine, in a multi-ethnic cohort, the association of first-trimester HbA1c levels with the development of pregnancy complications. METHODS A prospective study between April 2013-October 2016. Participants were stratified in five ethnic groups. Women had an HbA1c measurement added to their first antenatal bloods. Primary outcome was macrosomia and secondary outcomes included preeclampsia and large-for-gestational age (LGA). A multivariate logistic regression analysis was performed to adjust for potential confounders in determining the association between different HbA1c cut-off points and obstetric outcomes on each ethnic group. RESULTS 1,882 pregnancies were included. Analysis was limited to the three main ethnic groups: Caucasian (54.3%), South-Central Asian (19%) and Latin-American (12.2%). There was no association between HbA1c levels and obstetric outcomes among Caucasians. In Latin-Americans, an HbA1c ≥ 5.8% (40 mmol/mol) was associated with higher risk of macrosomia, whereas an HbA1c ≥ 5.9% (41 mmol/mol) was associated with LGA. In South-Central Asian, an HbA1c ≥ 5.7% (39 mmol/mol) was associated with increased risk of macrosomia and a continuous graded relationship between HbA1c levels and preeclampsia and LGA was detected starting at HbA1c levels of 5.4% (36 mmol/mol). CONCLUSION First-trimester HbA1c levels perform as a suitable predictor of pregnancy complications in South-Central Asian and Latin-American women whereas in Caucasian no significant associations were found.
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Affiliation(s)
- Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain
| | - Juana Antonia Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain.
| | - Nàdia Gómez
- Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain
| | - Juan José Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain.
| | - Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain.
| | - Lucía Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain
| | - Antonio Payà
- Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain; Department of Gynaecology and Obstetrics, Hospital del Mar, E-08003 Barcelona, Spain.
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain.
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, E-08003 Barcelona, Spain.
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7
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Mañé L, Flores-Le Roux JA, Benaiges D, Chillarón JJ, Prados M, Pedro-Botet J, Llauradó G, Gortazar L, Payà A. Impact of overt diabetes diagnosed in pregnancy in a multi-ethnic cohort in Spain. Gynecol Endocrinol 2019; 35:332-336. [PMID: 30328728 DOI: 10.1080/09513590.2018.1521387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Overt diabetes (ODM) is defined as women without diabetes meeting the criteria for diabetes at the first antenatal visit. The risk of obstetric complications increases linearly with maternal glycemia and poorer maternal-fetal outcomes than in gestational diabetes (GDM) may be expected. Studies focusing on ODM pregnancy outcomes are lacking. We aimed to analyze maternal characteristics and pregnancy outcomes in ODM women compared with those with GDM. A retrospective cohort study of women giving birth between January 2010 and April 2013 was conducted. Participants with pre-gestational diabetes were excluded. All women underwent screening for GDM at the 24th-28th weeks of gestation or at the first prenatal visit in those with risk factors. HbA1c and a fasting glucose were measured in GDM women to rule out ODM. Of the 5,633 women included, 572 (10%) were diagnosed with GDM and 50 (0.88%) with ODM. Almost 95% of ODM women were from ethnic minorities. After adjustment for confounding factors, ODM women showed increased rates of premature birth (23.1% vs. 6.7%, p < .001), emergent cesarean section (41.0% vs. 19.5%, p = .049), preeclampsia (22% vs. 3.7%, p < .001) and large-for-gestational-age babies (40.0% vs. 14.8%, p = .008) compared with GDM. In conclusion, ODM is associated with poorer obstetric outcomes than GDM and affects mainly women from ethnic minorities.
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Affiliation(s)
- Laura Mañé
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Juana Antonia Flores-Le Roux
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - David Benaiges
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Juan José Chillarón
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Montse Prados
- c Department of Endocrinology , Hospital de Martorell , Martorell , Spain
| | - Juan Pedro-Botet
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Gemma Llauradó
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Lucía Gortazar
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
| | - Antonio Payà
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
- d Department of Gynecology and Obstetrics , Hospital del Mar , Barcelona , Spain
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8
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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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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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10
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Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, Trevett C, Brain T, Gebski V, Corbould A. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ Open 2016; 6:e011059. [PMID: 27044587 PMCID: PMC4823451 DOI: 10.1136/bmjopen-2016-011059] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the most accepted measure of chronic glycaemia outside of pregnancy. HbA1c is an uncomplicated test, less time consuming, does not require any specific patient preparation and is considered straightforward compared with the OGTT. Therefore, we prospectively tested the utility of the HbA1c when used as a screening tool in pregnancy for gestational diabetes mellitus (GDM). SETTINGS Primary health care. Single tertiary referral centre, Tasmania, Australia. PARTICIPANTS A direct comparison between HbA1c levels and the OGTT results in pregnant women, tested concurrently at the 24-28 gestational week, was undertaken. A full profile of 480 pregnant women during the period from September 2012 to July 2014 was completed. Median and mean age of participants was 29 years (range 18-47 years). INTERVENTIONS A simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed. RESULTS The number of women who had GDM according to OGTT criteria was 57, representing 11.9% of the evaluated 480 pregnant women. Using a cut-off value for HbA1c at 5.1% (32 mmol/mol) for detecting GDM showed sensitivity of 61% and specificity of 68% with negative predictive value (NPV) of 93%, versus sensitivity of 27% and specificity of 95% with NPV of 91% when using HbA1c cut-off value of 5.4% (36 mmol/mol). CONCLUSIONS Our results suggest that pregnant women with an HbA1c of≥5.4% (36 mmol/mol) should proceed with an OGTT. This may result in a significant reduction in the burden of testing on both patients and testing facility staff and resources. Further investigations are required to integrate and optimise the HbA1c as a single, non-fasting, screening tool for GDM. TRIAL REGISTRATION NUMBER ACTRN12611000739910.
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Affiliation(s)
- Alhossain Khalafallah
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
- Menzies Institute for Medical Research, University of Tasmania, Launceston, Tasmania, Australia
| | - Eileen Phuah
- Department of Obstetrics and Gynaecology, Launceston General Hospital and Royal Hobart Hospital, Launceston, Tasmania, Australia
| | | | - Irena Nikakis
- Department of Obstetrics and Gynaecology, Launceston General Hospital and Royal Hobart Hospital, Launceston, Tasmania, Australia
| | - Andrea Radford
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Wade Clarkson
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Clinton Trevett
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Terry Brain
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Val Gebski
- Australian National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Anne Corbould
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
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11
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Shipman KE, Jawad M, Sullivan KM, Ford C, Gama R. Fructosamine; is the current interest in alternative glycaemic markers justified? Diabet Med 2015; 32:1116-7. [PMID: 25819596 DOI: 10.1111/dme.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/16/2022]
Affiliation(s)
- K E Shipman
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - M Jawad
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - K M Sullivan
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - C Ford
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - R Gama
- Clinical Chemistry, New Cross Hospital, Wolverhampton
- Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, UK
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12
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Rafat D, Rabbani TK, Ahmad J, Ansari MA. Influence of iron metabolism indices on HbA1c in non-diabetic pregnant women with and without iron-deficiency anemia: effect of iron supplementation. Diabetes Metab Syndr 2012; 6:102-105. [PMID: 23153978 DOI: 10.1016/j.dsx.2012.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Condition that influence erythrocyte turnover also affect HbA1c. Although many forms of anemia are associated with lowering of HbA1c, iron-deficiency anemia (IDA) tends to increase HbA1c. In this study, we examined the relationship between HbA1c and erythrocyte indices in non-diabetic pregnancy and assessed the effect of iron supplementation on HbA1c. MATERIALS AND METHODS 150 women were studied (30 non-diabetic), non-pregnant, non-anemic women in child bearing women with varying parity as controls (Gp 1); 30 non-diabetic, non-anemic pregnant women in first trimester of pregnancy (Gp 2a); 30 non-diabetic, non-anemic pregnant women in second trimester of pregnancy (Gp 2b); 30 non-diabetic, non-anemic pregnant women in third trimester of pregnancy (Gp 2c) and 30 non-diabetic pregnant women with IDA (Gp 2d). HbA1c, OGTT, erythrocyte indices and iron metabolic indices were determined in Gp 2d subjects not supplemented with iron and repeated these indices after 3 months of iron-supplementation. RESULTS The mean fasting and postprandial blood glucose levels (79.9±8.0mg/dl, 108.1±14.1mg/dl) in Gp 1 were found to be significantly lower in first trimester among Gp 2a (74.4±5.3mg/dl and 97.2±11.1mg/dl), in second trimester among Gp 2b (76.2±5.2mg/dl and 103.4±7.9mg/dl) followed by increase in IIIrd trimester among Gp 2c (82.3±5.7mg/dl and 112.5±8.5mg/dl) subjects. A significant difference in HbA1c was also observed among the groups (HbA1c 4.7±0.3% in Gp 1; 4.6±0.4% in Gp 2a; 4.5±0.3 in Gp 2b; 4.7±0.3 in Gp 2c). Among Gp 2d subjects, HbA1c was 5.2±0.3% and the level decreased after iron supplementation to 5.1±0.3%. Significant correlation between erythrocyte indices, iron metabolic indices and HbA1c was also observed. CONCLUSION We conclude that consideration should be given for performing glucose testing in patients with IDA to ascertain the reliability of HbA1c in the diagnosis of diabetes. HbA1c concentrations in diabetic patients with IDA should be interpreted with caution.
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MESH Headings
- Adolescent
- Adult
- Anemia, Iron-Deficiency/blood
- Anemia, Iron-Deficiency/diet therapy
- Anemia, Iron-Deficiency/epidemiology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diet therapy
- Diabetes Mellitus, Type 2/epidemiology
- Dietary Supplements
- Erythrocyte Indices
- Fasting/blood
- Female
- Glucose Tolerance Test
- Glycated Hemoglobin/metabolism
- Humans
- India/epidemiology
- Iron/administration & dosage
- Maternal-Child Health Centers
- Postprandial Period
- Prediabetic State/blood
- Prediabetic State/diet therapy
- Prediabetic State/epidemiology
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/diet therapy
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Trimester, First
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
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Affiliation(s)
- D Rafat
- Obstetrics and Gynaecology, J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, UP, India
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13
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Abstract
During pregnancy, the glucose levels vary according to the hormonal changes and the metabolic needs necessary to maintain fetal nutrition but strict glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by diabetes. Although considered the "gold standard" for diagnosis, measurement of glucose in the blood is subject to several limitations, many of which are not widely appreciated. Measurement of A1c for diagnosis is appealing as with one number, a total, integrated view of glycemia over time is derived though it has some inherent limitations. Thus, supplementation with HbA1c, as is common outside pregnancy, seems appropriate. Before pregnancy, the target for metabolic control in women with diabetes is HbA1c values near the normal range. However, the upper normal range of HbA1c during normal pregnancy is only sparsely investigated with different methods though recently a number of papers have been published regarding the determination of reference ranges for HbA1c in pregnancy. These changes may have clinical implications for the assessment and management of glycemic control in diabetic pregnancy and calls for establishment of separate reference limits of HbA1c levels in different trimesters as compared to general population.
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Affiliation(s)
- Dalia Rafat
- Department of Obstetrics and Gynecology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India
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14
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Abstract
Measurement of hemoglobin A1c (HbA1c) is considered the gold standard for monitoring chronic glycemia of diabetes patients. Hemoglobin A1c indicates an average of blood glucose levels over the past 3 months. Its close association with the risk for the development of long-term complications is well established. However, HbA1c does not inform patients about blood glucose values on a daily basis; therefore, frequent measurements of blood glucose levels are necessary for the day-to-day management of diabetes. Clinicians understand what HbA1c means and how it relates to glucose, but this is not the case with patients. Therefore, the translation of the HbA1c results into something more familiar to patients seemed a necessity. The scope of this article is to review the literature to search for enough scientific evidence to support the idea of a close relationship between HbA1c and mean blood glucose (MBG), and to justify the translation of HbA1c into something that reflects the MBG. Most studies confirm a close relationship between HbA1c and MBG, although different studies result in different linear equations. Factors affecting this relationship may limit the usefulness and applicability of a unique mathematical equation to all diabetes populations.
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15
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Kitzmiller JL, Wallerstein R, Correa A, Kwan S. Preconception care for women with diabetes and prevention of major congenital malformations. ACTA ACUST UNITED AC 2010; 88:791-803. [DOI: 10.1002/bdra.20734] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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16
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Herranz L, Saez-de-Ibarra L, Grande C, Pallardo LF. Non-glycemic-dependent reduction of late pregnancy A1C levels in women with type 1 diabetes. Diabetes Care 2007; 30:1579-80. [PMID: 17363748 DOI: 10.2337/dc06-2568] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lucrecia Herranz
- Unidad de Diabetes, Hospital Universitario La Paz, Madrid, Spain.
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17
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Mosca A, Paleari R, Dalfrà MG, Di Cianni G, Cuccuru I, Pellegrini G, Malloggi L, Bonomo M, Granata S, Ceriotti F, Castiglioni MT, Songini M, Tocco G, Masin M, Plebani M, Lapolla A. Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin Chem 2006; 52:1138-43. [PMID: 16601066 DOI: 10.1373/clinchem.2005.064899] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The reference intervals for hemoglobin A1c (Hb A1c) in pregnant women without diabetes are not well defined, and few examples of reference intervals established by networks of different laboratories are available. METHODS Five Italian Diabetic Care Units were involved in the study. Data were collected from 445 pregnant women without diabetes, selected on the basis of glucose challenge test results, and from 384 nonpregnant control women. The Hb A1c measurements were performed with HPLC systems aligned to the Diabetes Control and Complications Trial. Plasma glucose measurements were also performed locally. Both Hb A1c and glucose measurements were harmonized by running appropriate external quality assessment schemes. The reference intervals were calculated in terms of nonparametric 2.5th to 97.5th percentiles with 0.90 confidence intervals. RESULTS The Hb A1c measurements were reproducible (CV = 2.0%) and accurate [mean (SE) difference from the target values, -0.10 (0.06)%]. Glucose measurements were also reproducible (mean CV = 3.2%) and accurate [difference from the target values, -0.01 (0.04) mmol/L]. To calculate common reference intervals, we merged the data collected in the different centers. The Hb A1c reference intervals were 4.0%-5.5% for pregnant nondiabetic women and 4.8%-6.2% for nonpregnant controls. CONCLUSIONS Healthy pregnant women have lower Hb A1c concentrations than nonpregnant women. The reference intervals for Hb A1c in pregnant women should therefore be lower than those currently in use.
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Affiliation(s)
- Andrea Mosca
- Dipartimento di Scienze e Tecnologie Biomediche, Università degli Studi di Milano, Segrate (Milano), Italy.
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18
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Nielsen LR, Ekbom P, Damm P, Glümer C, Frandsen MM, Jensen DM, Mathiesen ER. HbA1c levels are significantly lower in early and late pregnancy. Diabetes Care 2004; 27:1200-1. [PMID: 15111545 DOI: 10.2337/diacare.27.5.1200] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lene R Nielsen
- Department of Endocrinology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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19
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O'Kane MJ, Lynch PL, Moles KW, Magee SE. Determination of a diabetes control and complications trial-aligned HbA(1c) reference range in pregnancy. Clin Chim Acta 2001; 311:157-9. [PMID: 11566175 DOI: 10.1016/s0009-8981(01)00579-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A diabetes control and complications trial (DCCT)-aligned 95% inter-fractile reference range for glycated haemoglobin in non-diabetic pregnancy was determined as 4.1-5.9% (n=493; two-sided 90% confidence intervals around the lower and upper limits are 4.0-4.2% and 5.8-6.0%, respectively).
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Affiliation(s)
- M J O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Area Hospital, Londonderry, BT47 6SB, UK
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20
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Hartland AJ, Smith JM, Dunne F. Correcting serum fructosamine concentration for total protein or albumin concentration is not appropriate during Asian pregnancy. Clin Chim Acta 2000; 292:175-80. [PMID: 10686287 DOI: 10.1016/s0009-8981(99)00215-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A J Hartland
- Department of Clinical Biochemistry, Central Pathology Laboratory, North Staffordshire Hospital NHS Trust, Stoke-on-Trent, ST4 7PA, UK
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