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Pre-gestational diabetes is associated with an elevated risk of pregnancy loss. However, it is unclear whether subclinical levels of glucose intolerance are associated with pregnancy loss, especially recurrent pregnancy loss (RPL). Thus, our objective was to compare maternal serum fructosamine (a marker of glycemic control) in patients with and without RPL.
Case-control study design with 134 women with unexplained RPL, defined as two or more pregnancy losses with no more than one live birth and 134 age-matched controls with at least one full term uncomplicated pregnancy and no more than one pregnancy loss. No cases or controls had a clinical diagnosis of pre-gestational or gestational diabetes. Maternal serum fructosamine was measured using quantitative spectrophotometry.
The groups were similar with regard to age, race and ethnicity. The mean BMI of cases was 26.4 (17.8-51.2) compared to 26.4 (17.8-44.4), p = 0.91. Fructosamine levels were higher in women with RPL (225.3 +/− 38.5) compared to controls (189.3 +/− 19.5, p <0.001). This was also seen when the cases and controls were stratified by BMI (see table). However, the proportion of women with elevated levels of fructosamine considered diagnostic of diabetes (≥ 285 μmol/L) was similar in cases and controls (6.0 versus 12.7%; p = 0.092).
1Fructosamine levels stratified by BMI
Cases and controls had a similar proportion of women with elevated levels of fructosamine considered diagnostic of clinically relevant glucose intolerance. However, maternal serum levels of fructosamine were increased in women with RPL compared to controls. Thus, subclinical levels of glucose intolerance may be associated with an increased risk of RPL. Although these data support further investigation into the mechanisms of pregnancy loss associated with glucose intolerance, they do not support testing for subclinical glucose intolerance on women with RPL.