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.
Highlights
Diabetes mellitus (DM) complicates 1% - 2% of pregnancies, and associates with high perinatal morbidity [1]
One thousand-five hundred and sixty five (1565) women with Gestational diabetes mellitus (GDM) recruited at the beginning of this study, and the study was completed with final analysis of the data for 1516 women (49 women were not included in the final analysis of the study because of preterm labor, incomplete records, delivery outside the hospital, and travelling) Figure 1
One thousand-five hundred and sixty five (1565) women with GDM recruited at the beginning of this study, and the study was completed with final analysis of the data for 1516 women (1123 controlled GDM, and 393 uncontrolled GDM)
Summary
Diabetes mellitus (DM) complicates 1% - 2% of pregnancies, and associates with high perinatal morbidity [1]. Gestational diabetes mellitus (GDM) defined as a glucose intolerance of any degree discovered for the first time during pregnancy [2]. Macrosomia is the most constant consequence of diabetes, and its severity is influenced by the maternal blood glucose levels. 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 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 de-
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