Abstract
Objective: To compare GA with A1Cin monitoring glycemic excursions during pregnancy. Research Design and Methods: This study included 30 women with Gestational Diabetes Mellitus (GDM) and an equal number with Normal Glucose Tolerance (NGT). GDM were followed up every 2 weeks till 36 - 37 weeks and NGT were reviewed monthly once. Fasting Plasma Glucose (FPG), Postprandial Plasma Glucose (PPG), Ferritin, GA and A1Cwere estimated. GDM were advised Medical Nutritional Therapy (MNT). Target glycemic control was FPG ~ 5 mmol/L and 2 hr PPG ~ 6.6 mmol/L. Non-responders to MNT were administered insulin. Results: In GDM, mean FPG was 5.16 ± 0.55 mmol/L in the first visit and 4.73 ± 0.52 mmol/L in the last visit. The PPG at first visit was 7.07 ± 1.51 mmol/L and 6.16 ± 0.70 mmol/L in the last visit. The mean GA was 12.48% ± 0.8%, 12.51% ± 0.9%, 12.40% ± 1.0%, 12.30% ± 0.86% and 12.38% ± 0.87% at the first, second, third, fourth and fifth visit respectively. The mean A1Cat first, third and fifth visits was 5.16% ± 0.35%, 5.24% ± 0.29% and 5.21% ± 0.28% respectively. In NGT women, mean FPG at first visit was 4.37 ± 0.37 mmol/L and 4.39 ± 0.43 mmol/L in the last visit. The mean PPG was 5.95 ± 1.01 mmol/L in the first visit and 5.75 ± 1.61 mmol/L in the last visit. The mean GA was 12.17% ± 0.85% in first visit and 12.10% ± 0.77% in the last visit. A1Cwas 4.84% ± 0.31% and 4.91% ± 0.33% in the first and last visit respectively. Conclusions: Glycemic control was observed earlier with GA than A1C. GA is a better indicator of recent past short-term glycemic control in GDM.
Highlights
Women with pre-gestational diabetes and their fetuses are at increased risk of developing serious complications compared with the non-diabetic pregnant women, includeing spontaneous abortion, preterm labor, hypertensive disorders, and delivery by cesarean section despite improved access and quality of antenatal care [1]
Gestational diabetes mellitus accounts for ~90% of cases where pregnancy is complicated by diabetes [2], with potentially long-reaching consequences, including increasing the risk of subsequently developing type 2 diabetes for both mother and child [3]
Disrupted metabolic homeostasis has been implicated as a possible cause [4]; fetal macrosomia may result from minor disturbances in glucose metabolism [5]
Summary
Women with pre-gestational diabetes and their fetuses are at increased risk of developing serious complications compared with the non-diabetic pregnant women, includeing spontaneous abortion, preterm labor, hypertensive disorders, and delivery by cesarean section despite improved access and quality of antenatal care [1]. Disrupted metabolic homeostasis has been implicated as a possible cause [4]; fetal macrosomia may result from minor disturbances in glucose metabolism [5] These observations indicate an optimum glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by glucose intolerance [6]. This is possible by home glucose monitoring by the glucometers which gives immediate glycemic level and by estimation of glycated proteins which indicate the glycemic excursions of the past few weeks to months. Seshiah et al / Open Journal of Obstetrics and Gynecology 3 (2013) 47-50 study was undertaken with the aim of comparing GA with A1C and out of them which would serve as a earlier marker of glycemic control during pregnancy
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