Mid-Pregnancy Fructosamine Measurement-Predictive Value for Gestational Diabetes and Association with Postpartum Glycemic Indices.

Véronique Gingras,Sheryl Rifas-Shiman,Karen Switkowski,Emily Oken,Marie-France Hivert

doi:10.3390/nu10122003

Véronique Gingras, Sheryl Rifas-Shiman + Show 3 more

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https://doi.org/10.3390/nu10122003

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Abstract

Screening for gestational diabetes mellitus (GDM) during pregnancy is cumbersome. Measurement of plasma fructosamine may help simplify the first step of detecting GDM. We aimed to assess the predictive value of mid-pregnancy fructosamine for GDM, and its association with postpartum glycemic indices. Among 1488 women from Project Viva (mean ± SD: 32.1 ± 5.0 years old; pre-pregnancy body mass index 24.7 ± 5.3 kg/m2), we measured second trimester fructosamine and assessed gestational glucose tolerance with a 50 g glucose challenge test (GCT) followed, if abnormal, by a 100 g oral glucose tolerance test (OGTT). Approximately 3 years postpartum (median 3.2 years; SD 0.4 years), we measured maternal glycated hemoglobin (n = 450) and estimated insulin resistance (HOMA-IR; n = 132) from fasting blood samples. Higher glucose levels 1 h post 50 g GCT were associated with higher fructosamine levels (Pearson’s r = 0.06; p = 0.02). However, fructosamine ≥222 µmol/L (median) had a sensitivity of 54.8% and specificity of 48.6% to detect GDM (area under the receiver operating characteristic curve = 0.52); other fructosamine thresholds did not show better predictive characteristics. Fructosamine was also weakly associated with 3-year postpartum glycated hemoglobin (per 1 SD increment: adjusted β = 0.03 95% CI [0.00, 0.05] %) and HOMA-IR (per 1 SD increment: adjusted % difference 15.7, 95% CI [3.7, 29.0] %). Second trimester fructosamine is a poor predictor of gestational glucose tolerance and postpartum glycemic indices.

Highlights

Gestational diabetes mellitus (GDM) carries risk of adverse outcomes for the mother and child [1], with a linear relation between maternal glucose levels during pregnancy and risk of adverse outcomes [2]
Participants included in this analysis were 32.1 ± 5.0 years old and had a pre-pregnancy body mass index (BMI) of 24.7 ± 5.3 kg/m2, a fructosamine level of 232.0 ± 45.8 μmol/L, and a glucose challenge test (GCT) result of 114.3 ± 26.3 mg/dL
Participants who smoked during pregnancy (β = −8.3 vs. never or former smokers, 95% CI [−15.5, −1.1] μmol/L) and with a higher maternal pre-pregnancy BMI had lower fructosamine levels

Summary

Introduction

Gestational diabetes mellitus (GDM) carries risk of adverse outcomes for the mother and child [1], with a linear relation between maternal glucose levels during pregnancy and risk of adverse outcomes [2]. Screening of all women in pregnancy between weeks 24 and 28 is currently recommended to ensure appropriate treatment of GDM and reduce associated risks [1,3]. GDM screening is essential to ensure appropriate care, yet the recommended approaches are burdensome for mothers and for healthcare personnel. Previous studies have attempted to identify simpler markers of abnormal glucose tolerance in pregnancy, for example, using glycated circulating proteins, but yielded inconclusive or conflicting results. Fructosamine is a marker of glycemic control with the advantage that it reflects shorter term glucose levels (prior two–three weeks) given the relatively rapid turnover of circulating proteins [11] (in contrast to ~120 days of erythrocytes)

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