No abstract

Control of plasma glucose is effective to reduce adverse neonatal events (ANE) for pregnant women with diabetes, including gestational diabetes (GDM); however, compliance can be poor. We examined the utility of glycated serum protein (GSP) and glycated albumin (%GA) to predict risk of ANE. Published studies have shown greater risk if %GA of ≥ 12 -15.8%, but population and trimester-specific cut-offs are needed. Additionally, BMI has been reported to affect %GA. We prospectively recruited pregnant women with type 2 diabetes or GDM and collected serum during the second and/or third trimesters. No exclusion criteria were used, but an attempt was made to recruit similar numbers of overweight and Class I, II, or III obese BMI. Enrolled subjects included 52% African-American and 41% Caucasian with median BMI 34.0 (25.0 - 70.4). Thirty bio-banked samples, matched for ethnicity, BMI and gestational age, from women with no evidence of diabetes were used as controls. GSP and %GA as well as various lipid markers were measured using methods from Roche or Diazyme (GSP, %GA) on automated analyzers. Our goals were to determine preliminary cut-off values for GSP and %GA to predict ANE and identify whether additional lipid markers may improve prediction. Of those delivered to date (n=55), two controls and four subjects experienced one or more ANE (macrosomia, hyperbilirubinemia, hypoglycemia or RSD). Using receiver operator curve analysis, trimester two values of %GA or GSP were much better at predicting ANE (AUC: 0.896, 0.910, respectively) than trimester three values (AUC: 0.662, 0.713, respectively). Our data suggests that a cut-off ≥ 11.8 %GA can effectively predict those at greatest risk in this population. Statistical analysis showed no differences in %GA or GSP between ethnicities or BMI subgroups. Additional data is needed to determine whether or not incorporation of lipid markers will improve risk prediction. However, only beta-hydroxybutyrate shows significant differences between subjects and controls. Disclosure J. L. Powers carson: None. E. B. Carter: None. Funding American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.); National Institutes of Health (P30DK020579)