Abstract P091: Performance Of Glycated Albumin As A Marker Of Hyperglycemia During Pregnancy: Results From The National Health And Nutrition Examination 1999-2004

Abstract

Background: Glycated albumin (GA) is FDA-cleared for use as a short-term (2-3 week) marker of glycemia. HbA1c is not recommended for use during pregnancy due to its lack of sensitivity and suboptimal performance due to alterations in blood volume and decreases in hemoglobin. It is unclear if GA has a role for monitoring hyperglycemia in pregnancy. Objective: We evaluated the performance of GA as a measure of hyperglycemia in pregnant women without pre-gestational diabetes and compared our results to those in a sample of similarly-aged non-pregnant women. Methods: We used data from 555 pregnant women aged 20-40 years with measurements of glycemic markers (GA, HbA1c, glucose) without pre-gestational diabetes who participated in the 1999-2004 NHANES. We used Pearson’s correlations and linear regression and evaluated the area under the curve (AUC) for GA to detect elevated glucose or HbA1c. Results were compared to 1607 NHANES women aged 20-40 who were not pregnant. Results: In pregnant women in the US, 1.9% had elevated HbA1c (≥5.7%), 4.4% had elevated glucose (≥100 mg/dL) and 1.9% had elevated GA (≥16.5%). The correlation of HbA1c and glucose was 0.21 in pregnant women and was 0.62 in the non-pregnant women. GA was poorly correlated with HbA1c (r=0.08) and glucose (r=0.17) in pregnant women and modestly associated with HbA1c (r=0.31) and glucose (r=0.35). In pregnancy, BMI was positively associated with HbA1c (r=0.33) and glucose (r=0.25) but was inversely associated with GA (r=-0.27). GA had poor discrimination for detecting mild hyperglycemia in pregnant women, defined as either HbA1c ≥5.7% (AUC=0.538) or glucose ≥100 mg/dL (AUC=0.499) ( Figure ). Similar patterns were observed in women who were not pregnant. Conclusions: Our results suggest that GA is not a useful marker to identify or monitor mild hyperglycemia in pregnancy. GA appears to be strongly affected by adiposity. Weight gain during pregnancy may explain the poor concordance of GA with traditional measures of glycemia in pregnant women.