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Serum Fructosamine and Glycosylated Hemoglobin in Monitoring the Glycemic Control in Gestational Diabetes Mellitus

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Document pages: 16 pages

Abstract: Background: Diabetes mellitus complicates 1 -2 of allpregnancies, and associates withhigh perinatal morbidity. Gestational diabetes mellitus (GDM) is treatablecondition, and women who have adequate glycemic control during pregnancy caneffectively decrease the adverse outcomes of GDM. Objectives: This studywas designed to compare the serum fructosamine, and the glycosylated hemoglobin(HbA1c), in monitoring the glycemic control in GDM. Patients and Methods: 1516 women with GDM included, and were advised for dietary modification toachieve proper glycemic control. If the target glucose levels were not reachedby the diet regimen or by the dietary modification, insulin was prescribed forthe studied women. The average values of the pre- and post-prandial glucose levels were calculated,and the insulin doses were adjusted to achieve the target glucose values duringthe antenatal visits. HbA1c, and fructosamine were measured to assess theglycemic control for the studied women. Results: The fructosamine, andthe HbA1c were significantly high in the uncontrolled GDM compared tocontrolled group, and there was positive significant correlation betweenfractuosamine, and HbA1c in monitoring the glycemic control in GDM (r = 0.93,and P = 0.001). The Odds ratio (OR), and relative risk (RR) analysis forthe current pregnancy outcome showed that the polyhydramnios (OR 3.8; RR 3.7), the cesarean delivery(OR 1.7; RR 1.4), the fetal macrosomia (OR 6.4; RR 6.3), the fetal anomalies(OR 6.5; RR 6.4), and the (IUFD) intrauterine fetal death (OR 8.7; RR 8.6) weresignificantly high in uncontrolled GDM group. In addition, the (NND) neonatal death(OR 11.6; RR 11.4), the neonatal intensive care unit (NICU) admission (OR 3.1;RR 2.9), the neonatal hyperbilirubinemia (OR 3.7; RR 3.6), the transienttachypnea of the newborn (OR 3.1; RR 2.9), and the neonatal hypoglycemia (OR3.5; RR 3.4) were significantly high in uncontrolled GDM group. Conclusion: Fructosamine assay is simple, reliable, useful indicator for the glycemiccontrol in GDM over the last 2 - 3 weeks, and poor glycemiccontrol in GDM increases the risk of adverse maternal and neonatal outcomes.

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