Determination of reference intervals of glycated albumin and hemoglobin A1c in healthy pregnant Japanese women and analysis of their time courses and influencing factors during pregnancy

Hiramatsu, Yuji; Shimizu, Ikki; Omori, Yasue; Nakabayashi, Masao

doi:10.1507/endocrj.k10e-410

Cited by 89 publications

(96 citation statements)

References 21 publications

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“…In support of our proposed early pregnancy HbA 1c threshold of $5.9% (41 mmol/mol), the reported upper limit of normal for a first-trimester HbA 1c in other populations with diverse ethnic backgrounds ranges from 5.5 to 5.7% (37-39 mmol/mol) (13,14,21,22). Two other studies have also reported a first-trimester HbA 1c measurement as a predictor of GDM.…”

Section: Discussionsupporting

confidence: 68%

An Early Pregnancy HbA1c ≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes

et al. 2014

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OBJECTIVEPregnant women with undiagnosed diabetes are a high-risk group that may benefit from early intervention. Extrapolating from nonpregnancy data, HbA 1c ‡6.5% (48 mmol/mol) is recommended to define diabetes in pregnancy. Our aims were to determine the optimal HbA 1c threshold for detecting diabetes in early pregnancy as defined by an early oral glucose tolerance test (OGTT) at <20 weeks' gestation and to examine pregnancy outcomes relating to this threshold. RESEARCH DESIGN AND METHODSDuring 2008-2010 in Christchurch, New Zealand, women were offered an HbA 1c measurement with their first antenatal bloods. Pregnancy outcome data were collected. A subset completed an early OGTT, and HbA 1c performance was assessed using World Health Organization criteria. RESULTSHbA 1c was measured at a median 47 days' gestation in 16,122 women. Of those invited, 974/4,201 (23%) undertook an early OGTT. In this subset, HbA 1c ‡5.9% (41 mmol/mol) captured all 15 cases of diabetes, 7 with HbA 1c <6.5% (<48 mmol/mol). This HbA 1c threshold was also 98.4% (95% CI 97-99.9%) specific for gestational diabetes mellitus (GDM) before 20 weeks (positive predictive value = 52.9%). In the total cohort, excluding women referred for GDM management, women with HbA 1c of 5.9-6.4% (41-46 mmol/mol; n = 200) had poorer pregnancy outcomes than those with HbA 1c <5.9% (<41 mmol/mol; n = 8,174): relative risk (95% CI) of major congenital anomaly was 2.67 (1.28-5.53), preeclampsia was 2.42 (1.34-4.38), shoulder dystocia was 2.47 (1.05-5.85), and perinatal death was 3.96 (1.54-10.16). CONCLUSIONSHbA 1c measurements were readily performed in contrast to the low uptake of early OGTTs. HbA 1c ‡5.9% ( ‡41 mmol/mol) identified all women with diabetes and a group at significantly increased risk of adverse pregnancy outcomes.

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Section: Discussionsupporting

confidence: 68%

An Early Pregnancy HbA1c ≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes

et al. 2014

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“…Hiramatsu et al 17. showed similar changes of GA levels, which gradually decreased as pregnancy progressed toward the third trimester, in healthy pregnant women.…”

Section: Discussionmentioning

confidence: 77%

“…Hiramatsu et al 17. studied 574 normal Japanese pregnant women and proposed that the reference interval for GA in normal pregnant women was 11.5–15.7%.…”

Section: Discussionmentioning

confidence: 99%

Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus

Wang²,

Tao

et al. 2015

J of Diabetes Invest

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Aims/IntroductionTo assess glycated albumin (GA) as a potential glycemic index in managing gestational diabetes mellitus (GDM).Materials and MethodsEligible pregnant women were divided into the GDM group with abnormal result on a 75‐g oral glucose tolerance test (OGTT) and the control (normal) group. GA measurements, Pearson's correlation analysis, multiple logistic regression and receiver operating characteristic curve analysis were obtained at the follow‐up examination of participants in the two groups.ResultsA total of 2,118 women were assigned to the GDM group (n = 639) and control group (n = 1,479). The mean level of serum GA in GDM group was significantly greater than that in the control group at both 24–28 and 36–38 weeks of gestation (P < 0.05). The area under the receiver operating characteristic curve for GA defining good glycemic control in GDM was 0.874 (95% confidence interval 0.811–0.938). The cut‐off point for the GA levels derived from the receiver operating characteristic curve was 11.60%, which had sensitivity and specificity for detecting a poor glycemic status of 75.93% and 86.36%, respectively. The risk of birthweight ≥3,500 g and macrosomia increased significantly with GA levels ≥13.00% at 24–28 weeks and ≥12.00% at 36–38 weeks of gestation.ConclusionsGA might be an appropriate and conveniently measured index that can detect poor glycemic control and predict birthweights in GDM women.

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“…The HbA1c level was an independent predictor for insulin therapy in our patients, although the glycated albumin level was not related to the requirement for insulin therapy. HbA1c levels decreased in the second trimester and increased in the third trimester during pregnancy, and glycated albumin levels decreased toward the third trimester in healthy Japanese women [20]. Measuring the glycated albumin level is recommended in order to achieve strict glycemic control during pregnancy, because changes in this level are rapid and marked.…”

Section: Discussionmentioning

confidence: 99%

Assessment of predictors of insulin therapy in patients with gestational diabetes diagnosed according to the IADPSG criteria

et al. 2016

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Aims and introduction It is helpful for both diabetologists and obstetricians to identify patients with gestational diabetes who require insulin therapy for glycemic control during pregnancy. The aim of the present study was to assess potential predictors of insulin requirement in patients with gestational diabetes. Materials and methods One hundred thirteen patients with gestational diabetes [mean age 34.2 ± 4.5 years; pre-gestational body mass index (BMI), 23.6 ± 6.0 kg/m 2 ] were included in this study. The associations between insulin requirement and the following factors were analyzed: clinical maternal characteristics, number of abnormal oral glucose tolerance test (OGTT) values, gestational age at diagnosis, plasma glucose levels measured during the OGTT, glycated hemoglobin (HbA1c) and glycated albumin levels, and serum C-peptide level before breakfast and 1 and 2 h after breakfast. Results Thirty-six patients (32 %) required insulin during pregnancy (''insulin group''); the remaining patients were treated with nutrition therapy (''nutrition group''). The insulin group had a higher pre-gestational BMI, higher fasting glucose level, higher area under the curve (AUC) for serum C-peptide level, higher HbA1c level, and a younger gestational age at diagnosis than the nutrition group (p \ 0.05, all). Logistic regression analysis showed that the pre-gestational BMI, AUC for serum C-peptide level, and the HbA1c level were independent predictors for the insulin group (p \ 0.05, all). Conclusions The results suggest that a high insulin resistance and HbA1c level may be associated with insulin requirement in patients with gestational diabetes.

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Determination of reference intervals of glycated albumin and hemoglobin A1c in healthy pregnant Japanese women and analysis of their time courses and influencing factors during pregnancy

Cited by 89 publications

References 21 publications

An Early Pregnancy HbA1c ≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes

An Early Pregnancy HbA1c ≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes

Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus

Assessment of predictors of insulin therapy in patients with gestational diabetes diagnosed according to the IADPSG criteria

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