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Evaluation of Glycemic Control Indexes During Pregnancy: The Role of HbA1c, Glycated Albumin, and Fructosamine

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Book cover Nutrition and Diet in Maternal Diabetes

Part of the book series: Nutrition and Health ((NH))

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Abstract

Studies have proven that even mild disturbances in glucose tolerance during pregnancy increase the incidence of adverse pregnancy outcome for the mother and her child. This led to reconsidering and change in definition of gestational diabetes mellitus (GDM). The “new” criteria of the International Association of the diabetes and pregnancy study groups (IADPSG) are based on the association of maternal glycemia with perinatal outcomes reported in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. With their implication, new targets are set as glycemic goal during pregnancy. Good glycemic control could not be obtained without markers that more accurately reflect variations in blood glucose levels and mean glycemic status for short‐term. In patients with diabetes glycated hemoglobin A1c (HbA1c) is a “gold standard” for diagnosis and evaluation of glycemia for past period of time. Results from several studies have proven that HbA1c is not a reliable parameter during pregnancy due to iron deficiency. On the other hand, glycated albumin (GA) is another index for evaluation of glycemia, which might be better compared to HbA1c and fructosamin, but its clinical significance should be studied carefully. The aim of the present chapter is to clarify the use of the different indexes for evaluation of glycemic control in pregnant women with glucose intolerance.

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Abbreviations

GDM:

gestational diabetes mellitus

HbA1c:

glycated hemoglobin A1c

GA:

glycated albumin

References

  1. International Diabetes Federation. IDF Diabetes Atlas 6th ed., URL: http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf, 2013.

  2. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.

    Article  PubMed  Google Scholar 

  3. Boyadzhieva MV, Atanasova I, Zacharieva S, Tankova T, Dimitrova V. Comparative analysis of current diagnostic criteria for gestational diabetes mellitus. Obstet Med. 2012;5(2):71–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Cabero Roura L, McIntyre HD, Morris JL, Divakar, H. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet (2015);131(3):30007–2.

    Google Scholar 

  5. Jarrett RJ. Reflections on gestational diabetes mellitus. Lancet. 1981;2(8257):1220–1.

    Article  CAS  PubMed  Google Scholar 

  6. Hunter DJ. Screening for gestational diabetes. Am J Obstet Gynecol. 1989;161(5):1423–4.

    Article  CAS  PubMed  Google Scholar 

  7. Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia–maternal characteristics and infant complications. Obstet Gynecol. 1985;66(2):158–61.

    CAS  PubMed  Google Scholar 

  8. Cordero L, Landon MB. Infant of the diabetic mother. Clin Perinatol. 1993;20(3):635–48.

    CAS  PubMed  Google Scholar 

  9. Hod M, Merlob P, Friedman S, Schoenfeld A, Ovadia J. Gestational diabetes mellitus. A survey of perinatal complications in the 1980s. Diabetes. 1991;2:74–8.

    Article  Google Scholar 

  10. Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus: an evaluation of predictive risk factors. Med J Aust. 2001;174(3):118–21.

    CAS  PubMed  Google Scholar 

  11. Ferrara A, Hedderson MM, Quesenberry CP, Selby JV. Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the carpenter and coustan plasma glucose thresholds. Diabetes Care. 2002;25(9):1625–30.

    Article  PubMed  Google Scholar 

  12. Opara PI, Jaja T, Onubogu UC. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria. Ital J Pediatr. 2010;36(1):77.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Vohr BR, McGarvey ST, Tucker R. Effects of maternal gestational diabetes on offspring adiposity at 4–7 years of age. Diabetes Care. 1999;22(8):1284–91.

    Article  CAS  PubMed  Google Scholar 

  14. Schaefer-Graf UM, Pawliczak J, Passow D, Hartmann R, Rossi R, Buhrer C, Harder T, Plagemann A, Vetter K, Kordonouri O. Birth weight and parental BMI predict overweight in children from mothers with gestational diabetes. Diabetes Care. 2005;28(7):1745–50.

    Article  PubMed  Google Scholar 

  15. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115(3):e290–6.

    Article  PubMed  Google Scholar 

  16. Metzger, B.E., T.A. Buchanan, D.R. Coustan, A. de Leiva, D.B. Dunger, D.R. Hadden, M. Hod, J.L. Kitzmiller, S.L. Kjos, J.N. Oats, et al., Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care, 2007;30 Suppl(2): S251–60.

    Google Scholar 

  17. O’Sullivan JB. Diabetes mellitus after GDM. Diabetes. 1991;40(Suppl 2):131–5.

    Article  PubMed  Google Scholar 

  18. Panzer S, Kronik G, Lechner K, Bettelheim P, Neumann E, Dudczak R. Glycosylated hemoglobins (GHb): an index of red cell survival. Blood. 1982;59(6):1348–50.

    CAS  PubMed  Google Scholar 

  19. Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care. 2011;34(2):518–23.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hanas R, John G. 2010 consensus statement on the worldwide standardization of the hemoglobin A1C measurement. Diabetes Care. 2010;33(8):1903–4.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gillett MJ. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: Diabetes Care 2009;32(7):1327–1334. Clin Biochem Rev, 2009;30(4):197–200.

    Google Scholar 

  22. Standards of medical care in diabetes–2010. Diabetes Care, 2010;33 Suppl 1:S11–61.

    Google Scholar 

  23. Organosation WH, Use of Glycated hemoglobin (HbA1c) in the diagnosis of diabetes mellitus. 2011.

    Google Scholar 

  24. Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. Lancet. 2011;378(9786):169–81.

    Article  PubMed  Google Scholar 

  25. Ц AТ, Оценка на общ и индувидуален риск за захарен диабет. Дисертационен труд за присъжданер на научна степен. Доктор на медицинските науки 2012.

    Google Scholar 

  26. Agarwal MM, Dhatt GS, Punnose J, Koster G. Gestational diabetes: a reappraisal of HBA1c as a screening test. Acta Obstet Gynecol Scand. 2005;84(12):1159–63.

    Article  PubMed  Google Scholar 

  27. Moses RG. HbA1c and the diagnosis of gestational diabetes mellitus–a test whose time has not yet come. Diabetes Res Clin Pract. 2012;98(1):3–4.

    Article  CAS  PubMed  Google Scholar 

  28. Rajput R, Yogesh Y, Rajput M, Nanda S. Utility of HbA1c for diagnosis of gestational diabetes mellitus. Diabetes Res Clin Pract. 2012;98(1):104–7.

    Article  CAS  PubMed  Google Scholar 

  29. Ye M, Liu Y, Cao X, Yao F, Liu B, Li Y, Wang Z, Xiao H. The utility of HbA1c for screening gestational diabetes mellitus and its relationship with adverse pregnancy outcomes. Diabetes Res Clin Pract. 2016;114:43–9.

    Article  CAS  PubMed  Google Scholar 

  30. Aldasouqi SA, Solomon DJ, Bokhari SA, Khan PM, Muneera S, Gossain VV. Glycohemoglobin A1c: A promising screening tool in gestational diabetes mellitus. Int J Diabetes Dev Ctries. 2008;28(4):121–4.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mikkelsen MR, Nielsen SB, Stage E, Mathiesen ER, Damm P. High maternal HbA1c is associated with overweight in neonates. Dan Med Bull, 2011;58(9).

    Google Scholar 

  32. Sarwar N, Aspelund T, Eiriksdottir G, Gobin R, Seshasai SR, Forouhi NG, Sigurdsson G, Danesh J, Gudnason V. Markers of dysglycaemia and risk of coronary heart disease in people without diabetes: Reykjavik prospective study and systematic review. PLoS Med. 2010;7(5):1000278.

    Article  Google Scholar 

  33. O’Shea P, O’Connor C, Owens L, Carmody L, Avalos G, Nestor L, Lydon K, Dunne FP. Trimester-specific reference intervals for IFCC standardised haemoglobin A(1c): new criterion to diagnose gestational diabetes mellitus (GDM)? Ir Med J. 2012;105(5 Suppl):29–31.

    PubMed  Google Scholar 

  34. Rowan J, Allen H, Budden A, Elder R, Farrant M, Hughes R, Ivanova V, Moore P, Marnoch C, McGrath N. New Zealand National GDM Guidelines: an alternative view of some good practice points. Aust N Z J Obstet Gynaecol. 2015;55(1):17–20.

    Article  PubMed  Google Scholar 

  35. Mills JL, Jovanovic L, Knopp R, Aarons J, Conley M, Park E, Lee YJ, Holmes L, Simpson JL, Metzger B. Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study. Metabolism. 1998;47(9):1140–4.

    Article  CAS  PubMed  Google Scholar 

  36. Lurie S, Mamet Y. Red blood cell survival and kinetics during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000;93(2):185–92.

    Article  CAS  PubMed  Google Scholar 

  37. Hashimoto K, Noguchi S, Morimoto Y, Hamada S, Wasada K, Imai S, Murata Y, Kasayama S, Koga M. A1C but not serum glycated albumin is elevated in late pregnancy owing to iron deficiency. Diabetes Care. 2008;31(10):1945–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Phelps RL, Honig GR, Green D, Metzger BE, Frederiksen MC, Freinkel N. Biphasic changes in hemoglobin A1c concentrations during normal human pregnancy. Am J Obstet Gynecol. 1983;147(6):651–3.

    Article  CAS  PubMed  Google Scholar 

  39. Hashimoto K, Koga M. Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus. World J Diabetes. 2015;6(8):1045–56.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Pan J, Zhang F, Zhang L, Bao Y, Tao M, Jia W. Influence of insulin sensitivity and secretion on glycated albumin and hemoglobin A1c in pregnant women with gestational diabetes mellitus. Int J Gynaecol Obstet. 2013;121(3):252–6.

    Article  CAS  PubMed  Google Scholar 

  41. Hashimoto K, Osugi T, Noguchi S, Morimoto Y, Wasada K, Imai S, Waguri M, Toyoda R, Fujita T, Kasayama S, et al. A1C but not serum glycated albumin is elevated because of iron deficiency in late pregnancy in diabetic women. Diabetes Care. 2010;33(3):509–11.

    Article  CAS  PubMed  Google Scholar 

  42. Li HP, Wang FH, Tao MF, Huang YJ, Jia WP. Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus. J Diabetes Investig. 2016;7(1):48–55.

    Article  CAS  PubMed  Google Scholar 

  43. Yoshiuchi K, MM, Katakami N, Nakatani Y, Sakamoto K, Matsuoka T, Umayahara Y, Kosugi K, Kaneto H, Yamasaki Y, et al. Glycated albumin is a better indicator for glucose excursion than glycated hemoglobin in type 1 and type 2 diabetes. Endocr J. 2008;55: 503–507.

    Google Scholar 

  44. Wu WC, Ma WY, Wei JN, Yu TY, Lin MS, Shih SR, Hua CH, Liao YJ, Chuang LM, Li, HY. Serum Glycated Albumin to Guide the Diagnosis of Diabetes Mellitus. PLoS One. 2016;11(1).

    Google Scholar 

  45. Kim MK, Yun KJ, Kwon HS, Baek KH, Song KH. Discordance in the levels of hemoglobin A1C and glycated albumin: Calculation of the glycation gap based on glycated albumin level. J Diabetes Complications. 2016;30(3):477–81.

    Article  PubMed  Google Scholar 

  46. Peterson CM, Jones RL. Minor hemoglobins, diabetic “control”, and diseases of postsynthetic protein modification. Ann Intern Med. 1977;87(4):489–91.

    Article  CAS  PubMed  Google Scholar 

  47. Hughes PF, Agarwal M, Newman P, Morrison J. An evaluation of fructosamine estimation in screening for gestational diabetes mellitus. Diabet Med. 1995;12(8):708–12.

    Article  CAS  PubMed  Google Scholar 

  48. Agarwal MM, Dhatt GS, Othman Y, Ljubisavljevic MR. Gestational diabetes: an evaluation of serum fructosamine as a screening test in a high-risk population. Gynecol Obstet Invest. 2011;71(3):207–12.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The author’s work presented here has been funded under grant: DO 02/7 2008 National Science Fund, Ministry of Education and Science.

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Authors and Affiliations

  1. Clinical Center of Endocrinology, USBALE “Acad. Ivan Penchev”, Medical University of Sofia, 2 “Zdrave” str, 1431, Sofia, Bulgaria

    Maria Boyadzhieva

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  1. Maria Boyadzhieva
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Correspondence to Maria Boyadzhieva .

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Editors and Affiliations

  1. Department of Nutrition, King’s College London, London, United Kingdom

    Rajkumar Rajendram

  2. Department of Nutrition, King’s College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Boyadzhieva, M. (2018). Evaluation of Glycemic Control Indexes During Pregnancy: The Role of HbA1c, Glycated Albumin, and Fructosamine. In: Rajendram, R., Preedy, V., Patel, V. (eds) Nutrition and Diet in Maternal Diabetes. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-56440-1_3

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  • DOI: https://doi.org/10.1007/978-3-319-56440-1_3

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