Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes

Abstract

Background: Many efforts have been focused on the alternative glycemic marker glycated albumin (GlyA) and its application in pregnancy during which profound physiological changes take place. Our objective was to determine the reference intervals (RIs) of GlyA in healthy Chinese pregnant women and to assess the predictive value of serum GlyA in adverse pregnancy outcomes. Methods: Totally 421 healthy subjects including 137 in the first trimester, 152 in the second trimester, and 132 in the third trimester were enrolled from March to July 2019, for the purpose of establishing the trimester-specific RIs of GlyA. In addition, 67 pregnant women diagnosed with GDM were enrolled at 24-28 weeks of gestation. The diagnostic value of GlyA for GDM patients was evaluated and compared with that of fasting plasma glucose (FPG) at 24-28 weeks of gestation. The association between GlyA in the late pregnancy and the adverse pregnancy outcomes was analyzed with the data collected from January to June 2018 at our hospital. Results: The estimated RIs of GlyA in present study were 11.26-15.10%, 10.04-13.50%, and 9.76-13.09% in the first, second, and third trimesters respectively. The areas under receiver operating characteristic (ROC) curves were 0.503 for GlyA and 0.705 for FPG. More importantly, the GlyA level in the third trimester was not more elevated in the patients with adverse pregnancy outcomes including large for gestational age (LGA), preterm delivery, hypertension and preeclampsia (PE). The exception was made with the GDM patients who suffered from postpartum hemorrhage and had significantly higher GlyA levels than the control group. Conclusions: Our results showed that the GlyA was continuously decreased as the gestational age went up. The GlyA testing has limited value in diagnosing GDM and predicting adverse pregnancy outcomes.

Fetal glycated albumin levels in offspring of obese women

“…However, matching for gestational age was performed to address gestational age as a confounder. Dong et al found that with increasing gestational age, maternal serum GA decreased in women with GD who were normoglycemic 20 . We found lower maternal GA levels among obese women and this is in keeping with Hiramatsu et al’s findings that maternal GA levels decreased more in obese women as the pregnancy progressed to the third trimester 21 .…”

“…Dong et al found that with increasing gestational age, maternal serum GA decreased in women with GD who were normoglycemic. 20 We found lower maternal GA levels among obese women and this is in keeping with Hiramatsu et al's findings that maternal GA levels decreased more in obese women as the pregnancy progressed to the third trimester. 21 Their explanation for this was that albumin turnover may be increased in obese women because of their chronic low-grade inflammatory state.…”

Glycated Albumin and Glycemia in Pregnancy and Postpartum: A Pilot Study

“…Our study reaffirmed the findings of other investigators that BMI has an inverse relationship with %GAlb throughout gestation. 20,23 BMI did not decline to its early pregnancy state, reflecting weight retention in the PP period. The lack of PP weight loss may be partially responsible for the lack of return of %GAlb to nonpregnant levels, as higher BMI may have been correlated with lower %GAlb levels, but BMI did not completely explain the findings in adjusted models.…”

“…Others have examined the behavior of this biomarker during gestation to examine its role in gestational diabetes diagnosis, monitoring, and predicting neonatal outcomes 20,26,36 ; however, the PP period was not included in their analyses. While some investigators have proposed that % GAlb is useful in correlation with self-monitored postprandial glycemia among pregnancies affected by GDM, 23,37 these studies were restricted to those with GDM compared with controls and did not control for the effect of BMI on %GAlb.…”

“…[14][15][16][17][18] Outside of pregnancy, percent glycated albumin (%GAlb) correlates well with glycemia in the preceding 2 to 3 weeks and is unaffected by red cell turnover, anemia, or iron deficiency. [19][20][21][22] Offsetting these advantages, %GAlb is inversely correlated with body mass index (BMI), which diminishes its usefulness as a glycemic marker when BMI is changing. 20,23 Prior reports of %GAlb as a marker of glycemia during pregnancy 18,20,[22][23][24][25][26][27][28][29] have been limited by inclusion of pregnancies affected by GDM only, lack of an established reference range for %GAlb in pregnancy, or exclusion of the PP period.…”