Glycosylated hemoglobin as a screening test for carbohydrate intolerance in pregnancy

Cousins, Larry; Dattel, Bonnie J.; Hollingsworth, Dorothy R.; Zettner, Alfred

doi:10.1016/s0002-9378(84)90420-4

Cited by 42 publications

(23 citation statements)

References 27 publications

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“…If the oGTT alone is used to diagnosis of gestational diabetes, AFI must be measured in 4.27% of all pregnant women. Measuring fructosamine only, 2.44% would require amniocentesis to measure (Carpenter and Coustan 1982, Cousins et al 1984, Peterson and Jovanovic 1988, Fuhrmann 1988, Weiss 1988. Numerous other guidelines have been proposed for the diagnosis of GD, all of them oriented towards maternal parameters (World Health Organization (WHO 1980).…”

Section: Resultsmentioning

confidence: 99%

Fructosamine in relation to maternofetal glucose and insulin homeostasis in gestational diabetes

Hofmann

1990

Arch Gynecol Obstet

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The problem in screening for gestational diabetes is recognizing fetuses endangered by hyperinsulinism. 21.8% of patients with gestational diabetes (defined as a glucose peak exceeding 160 mg/dl after an oral glucose load of 1 g per kg body weight) develop fetal hyperinsulinism. Thus, is indicated by an elevated amniotic fluid insulin (AFI) concentration and requires insulin treatment. Since fetal hyperinsulinism can be neither predicted nor ruled out by single parameters of maternal metabolism, every patient with gestational diabetes had to undergo amniocentesis for amniotic fluid analysis. In 110 gestational diabetics and 822 controls, fetal hyperinsulinism was predicted by the combination of the oGTT (greater than or equal to 160 mg/dl) and maternal serum fructosamine (greater than or equal to 2.6 mmol/l) with a sensitivity of 95.8% and a specificity of 91.8%. Thus, 73% of gestational diabetics need not undergo amniocentesis. With a sensitivity of 20.8%, the combination of the oGTT and HbA1c is not useful in identifying hyperinsulinemic fetuses.

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Section: Resultsmentioning

confidence: 99%

Fructosamine in relation to maternofetal glucose and insulin homeostasis in gestational diabetes

Hofmann

1990

Arch Gynecol Obstet

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“…They concluded that the HbAi test was inadequate as a screening procedure for gestational diabetes. Cousins et al [9] compared the 1-hour GCT and HbAi in a cohort of 806 pregnant subjects and reported a considerable over lap of HbAi values between normal subjects (4.0-10.9%) and carbohydrate-intolerant subjects (6.9-11.5%). Bacigalupo et al [18] noted that only half of the HbAi values (26 of 51) in patients with gestational diabetes would be abnormal if a 1 SD threshold limit was used.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, HbAi may not be effective in screening for diabetics [9], While these results may indicate that HbAi measure ments are inadequate as a screening tool for diabetes mellitus, many experts believe that these measurements are an important adjunct measure to check the validity of a patient's home glucose measurements [23][24][25], Glycosy lated hemoglobin measurements may be useful in preg nant patients to establish the baseline degree of control [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…They found a 69% agreement between the two tests and a high false-positive (41%) and false negative (26%) rate for HbAi at 7% concentration of HbAi, proving that this test was inadequate as a screening procedure for gestational diabetes. In a prenatal screening test for carbohydrate intolerance, Cousins et al [9] found that the 1-hour glucose challenge test (GCT) had greater specificity, sensitivity and predictive value for a positive diagnosis than the HbA] test. In contrast, Morris et al [10] reported that HbAi, determined by affinity chroma tography, may be used as a sensitive predictor of patients who will develop gestational diabetes during early preg nancy (10-15 weeks).…”

Section: Introductionmentioning

confidence: 99%

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Glycosylated Hemoglobins in Pregnant Women with Normal and Abnormal Glucose Tolerance

Loke

Chua²,

Kek³

et al. 1994

Gynecol Obstet Invest

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Glycosylated hemoglobin (HbA₁) levels were compared in low risk pregnant Singaporean women with normal and abnormal glucose response. HbA₁ (mean ± 1 SD) levels in normal and abnormal groups (489 and 72, respectively) were 4.65 ± 0.49 and 4.85 ± 0.50, respectively. While mean levels were significantly different, there was a considerable overlap of levels in both groups. At various gestation periods, mean HbAi levels between normal and abnormal groups showed significant difference only at late gestation. The latter may have contributed to significant differences in HbA₁ levels between normal and abnormal groups as a whole. The considerable overlap of HbA₁ values in normal and abnormal groups indicate that HbA₁ may be insensitive as a screening method for glucose intolerance.

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“…Cousins et al (1984) showed that the 1-hour oGTT value is markedly more sensitive than HbA1 for screening for GD. Changes in the levels of HbAlc depend on the glucose level and on the life span of the erythrocytes.…”

Section: Discussionmentioning

confidence: 99%

Maternal serum fructosamine and maternofetal glucose and insulin homeostasis in normal pregnancy

Hofmann

1990

Arch Gynecol Obstet

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Well-defined normal values are necessary to identify pregnancies complicated by gestational diabetes (GD) and thus further reduce perinatal morbidity and mortality from this condition. The present study defined the range for the oral glucose tolerance test (oGTT) in 2578 pregnancies. After exclusion of abnormal results 822 randomized patients were used to define normal values for fructosamine, HbA1c, insulin, glucose and C-peptide in the maternal serum; insulin, glucose and fructosamine in the amniotic fluid; and insulin, glucose, C-peptide and fructosamine in the cord blood.

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Glycosylated hemoglobin as a screening test for carbohydrate intolerance in pregnancy

Cited by 42 publications

References 27 publications

Fructosamine in relation to maternofetal glucose and insulin homeostasis in gestational diabetes

Fructosamine in relation to maternofetal glucose and insulin homeostasis in gestational diabetes

Glycosylated Hemoglobins in Pregnant Women with Normal and Abnormal Glucose Tolerance

Maternal serum fructosamine and maternofetal glucose and insulin homeostasis in normal pregnancy

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