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Fructosamine remains unutilized in clinical obstetrics, though it is considered superior to hemoglobin A1c in non-pregnant settings complicated by anemia, as a marker of chronic glycemic control. We aimed to compare fructosamine, hemoglobin A1c, and fasting glucose in their association with neonatal morbidity and macrosomia.
We performed a prospective cohort study of women with gestational (GDM) and Type-II diabetes (DM-II), singletons, and no known anomalies. Daily fasting serum glucose, hemoglobin (Hgb) A1c and fructosamine each trimester, as well as measures at delivery were recorded. Detailed medical and pregnancy history were recorded. Primary outcome was composite neonatal morbidity, defined as one or more of: respiratory distress syndrome (RDS), hyperbilirubinemia (HB), perinatal death, shoulder dystocia, hypoglycemia requiring treatment. Secondary outcomes included macrosomia (>4000g), and the individual components of the composite. Generalized estimating equations (GEE) were used to estimate the risk of composite morbidity, accounting for repeated measures and adjusting for confounders. Analyses were repeated stratified by DM-II vs GDM.
301 women met eligibility; 97 with GDM and 204 with DM II. There was a high incidence of the composite morbidity (n=147, 48.1%) as well as macrosomia (n=49, 16.3%); but composite morbidity occurred less frequently in women with GDM v. DM-II (42.3% v. 51.9%, p=0.01). Elevated fructosamine, even >210, was not significantly associated with an increased risk of morbidity (aOR 1.55, 95%CI 0.84 - 2.86) or macrosomia (aOR 2.14, 95%CI 0.95 - 4.80); elevated mean fasting values also showed no significant association. However, elevated Hgb A1c >8.0 was significantly associated with morbidity and macrosomia.
Fructosamine was not found to be a useful tool to predict neonatal morbidity in pregnancies complicated by GDM and DM-II. However, HgbA1c was associated with adverse birth outcomes and should be used clinically for counseling.