Serum Fructosamine and Glycosylated Hemoglobin in Monitoring the Glycemic Control in Gestational Diabetes Mellitus

摘要

Background: Diabetes mellitus complicates 1%-2% of all pregnancies, and associates with high perinatal morbidity. Gestational diabetes mellitus (GDM) is treatable condition, and women who have adequate glycemic control during pregnancy can effectively decrease the adverse outcomes of GDM. Objectives: This study was designed to compare the serum fructosamine, and the glycosylated hemoglobin (HbA1c), in monitoring the glycemic control in GDM. Patients and Methods: 1516 women with GDM included, and were advised for dietary modification to achieve proper glycemic control. If the target glucose levels were not reached by the diet regimen or by the dietary modification, insulin was prescribed for the studied women. The average values of the pre- and post-prandial glucose levels were calculated, and the insulin doses were adjusted to achieve the target glucose values during the antenatal visits. HbA1c, and fructosamine were measured to assess the glycemic control for the studied women. Results: The fructosamine, and the HbA1c were significantly high in the uncontrolled GDM compared to controlled group, and there was positive significant correlation between fractuosamine, and HbA1c in monitoring the glycemic control in GDM (r = 0.93, and P = 0.001). The Odds ratio (OR), and relative risk (RR) analysis for the current pregnancy outcome showed that the polyhydramnios (OR 3.8;RR 3.7), the cesarean delivery (OR 1.7;RR 1.4), the fetal macrosomia (OR 6.4;RR 6.3), the fetal anomalies (OR 6.5;RR 6.4), and the (IUFD) intrauterine fetal death (OR 8.7;RR 8.6) were significantly high in uncontrolled GDM group. In addition, the (NND) neonatal death (OR 11.6;RR 11.4), the neonatal intensive care unit (NICU) admission (OR 3.1;RR 2.9), the neonatal hyperbilirubinemia (OR 3.7;RR 3.6), the transient tachypnea of the newborn (OR 3.1;RR 2.9), and the neonatal hypoglycemia (OR 3.5;RR 3.4) were significantly high in uncontrolled GDM group. Conclusion: Fructosamine assay is simple, reliable, useful indicator for the glycemic control in GDM over the last 2 - 3 weeks, and poor glycemic control in GDM increases the risk of adverse maternal and neonatal outcomes.