Maternal serum fructosamine levels and stillbirth: a case–control study of the Stillbirth Collaborative Research Network

Abstract

Objective To evaluate the association between maternal fructosamine levels at the time of delivery and stillbirth. Design Secondary analysis of a case–control study. Setting Multicentre study of five geographic catchment areas in the USA. Population All singleton stillbirths with known diabetes status and fructosamine measurement, and representative live birth controls. Main outcome measures Fructosamine levels in stillbirths and live births among groups were adjusted for potential confounding factors, including diabetes. Optimal thresholds of fructosamine to discriminate stillbirth and live birth. Results A total of 529 women with a stillbirth and 1499 women with a live birth were included in the analysis. Mean fructosamine levels were significantly higher in women with a stillbirth than in women with a live birth after adjustment (177 ± 3.05 versus 165 ± 2.89 μmol/L, P < 0.001). The difference in fructosamine levels between stillbirths and live births was greater among women with diabetes (194 ± 8.54 versus 162 ± 3.21 μmol/L), compared with women without diabetes (171 ± 2.50 versus 162 ± 2.56 μmol/L). The area under the curve (AUC) for fructosamine level and stillbirth was 0.634 (0.605–0.663) overall, 0.713 (0.624–0.802) with diabetes and 0.625 (0.595–0.656) with no diabetes. Conclusions Maternal fructosamine levels at the time of delivery were higher in women with stillbirth compared with women with live birth. Differences were substantial in women with diabetes, suggesting a potential benefit of glycaemic control in women with diabetes during pregnancy. The small differences noted in women without diabetes are not likely to justify routine screening in all cases of stillbirth. Tweetable abstract Maternal serum fructosamine levels are higher in women with stillbirth than in women with live birth, especially in women with diabetes.

Reducing health inequality in Black, Asian and other minority ethnic pregnant women: impact of first trimester combined screening for placental dysfunction on perinatal mortality

“…This is most likely due to an already very low perinatal death rate in this group of 2.6/1000 pregnancies. It is also noteworthy that just under half of the perinatal deaths in the entire cohort occurred in pregnancies with complications such as pre‐eclampsia or diabetes, suggesting that increased monitoring and early intervention in these women may be justified 20 . Regular fetal wellbeing assessments such as fetal growth assessment, fetal Doppler and fetal heart rate (FHR) monitoring with computerised cardiotocography (cCTG) may be beneficial in at‐risk pregnancies.…”

“…It is also noteworthy that just under half of the perinatal deaths in the entire cohort occurred in pregnancies with complications such as pre-eclampsia or diabetes, suggesting that increased monitoring and early intervention in these women may be justified. 20 Regular fetal wellbeing assessments such as fetal growth assessment, fetal Doppler and fetal heart rate (FHR) monitoring with computerised cardiotocography (cCTG) may be beneficial in at-risk pregnancies. However, these methods of surveillance would only provide a brief window of insight into fetal wellbeing during the period of actual monitoring and are likely to be limited by the frequency of appointments and availability of healthcare professionals.…”

Fructosamine and HbA1c A: Correlational Study in a Southeast Asian Population

“…[14][15][16] It is reportedly more suitable in monitoring blood glucose 17 and predicted stillbirths in pregnant women with diabetes. 18 One benefit of using fructosamine as a marker of glycaemic control is that it is not affected by erythrocyte lifespan or haemoglobin structure 12 as compared to HbA1c. This is of particular importance in Southeast Asia where iron deficiency and haemoglobin variants are highly prevalent.…”