TITLE:
Serum Fructosamine and Glycosylated Hemoglobin in Monitoring the Glycemic Control in Gestational Diabetes Mellitus
AUTHORS:
Mohamed M. Farghali, Ali M. Mahmoud, Ghassan Baidas, Mohamed M. Khalafalla, Ibrahim A. Abdelazim, Shikanova Svetlana
KEYWORDS:
Serum Fructosamine, HbA1c, GDM
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.6,
June
25,
2018
ABSTRACT: 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.