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Glycated Albumin and Glycemia in Pregnancy and Postpartum: A Pilot StudyFunding Research reported in this manuscript was supported by the National Institutes of Health under award number NIDDK K23DK113218 and the Robert Wood Johnson Foundation's Harold Amos Medical Faculty Development Program. Data collection was also supported by the Clinical Research Center at Massachusetts General Hospital under grant number 1UL1TR002541-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources, the National Center for Advancing Translational Science, or the National Institutes of Health. Additional funding support was provided by the Department of Obstetrics, Gynecology, and Reproductive Biology at Massachusetts General Hospital.
Objective Percent glycated albumin (%GAlb) is a marker of glycemia over the past 2 to 3 weeks in nonpregnant individuals. Longitudinal changes in %GAlb extending throughout pregnancy and postpartum (PP) have not been described. We aimed to describe levels of %GAlb throughout pregnancy and PP and relationships with glycemia.
Study Design Fifty women among those in the Study of Pregnancy Regulation of INsulin and Glucose cohort underwent 75-g oral glucose tolerance tests (OGTTs) at a mean of 13 weeks (V1) and 26 weeks (V2) of gestation and 11 weeks' PP. %GAlb was measured on frozen plasma samples.
Results Total albumin decreased from V1 to V2 and increased PP to levels higher than at V1. %GAlb declined between V1 and V2 (β = − 0.63% 95% CI [−0.8, −0.6] p < 0.001) and remained stable between V2 and PP (β = − 0.04% [−0.3, 0.2] p = 0.78). Body mass index (BMI) was inversely related to %GAlb in pregnancy (V1: rho = − 0.5, p = 0.0001; V2 rho = − 0.4, p = 0.006), but not PP (rho = − 0.15, p = 0.31). The longitudinal changes in %GAlb persisted after adjusting for BMI. Neither glycemia measurements nor hemoglobin A1c were associated with %GAlb at any time point, and adjustments for BMI did not reveal additional associations.
Conclusion %GAlb decreases between early and late gestation and remains decreased PP, despite a PP increase in total albumin above early pregnancy values. Given the lack of correlation with OGTT values or A1c, %GAlb is unlikely to be useful in assessing glycemia in pregnant or PP women.
Changes in %GAlb extending to the postpartum period have not been described.
%GAlb decreases in pregnancy and remains decreased postpartum, despite a postpartum increase in total albumin above early pregnancy values.
Glycemia measurements nor A1c were associated with %GAlb at any time point, therefore, %GAlb is unlikely to be useful in assessing glycemia in pregnant or postpartum women.
Keywordsgestational diabetes - gestational glycemia - glycated albumin - pregnancy biomarkers - postpartum diabetes - postpartum screening
This work was presented at the American Diabetes Association (ADA) Annual Meeting, held virtually June 2021.
Received: 08 February 2023
Accepted: 21 July 2023
Article published online:
28 August 2023
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- 1 Waters TP, Kim SY, Werner E. et al. Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes?. Am J Obstet Gynecol 2020; 222 (01) 73.e1-73.e11
- 2 Correa A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J 2015; 19 (03) 635-642
- 3 Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth - United States, 2012-2016. MMWR Morb Mortal Wkly Rep 2018; 67 (43) 1201-1207
- 4 ACOG Practice Bulletin No. ACOG practice bulletin no. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
- 5 England LJ, Dietz PM, Njoroge T. et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol 2009; 200 (04) 365.e1-365.e8
- 6 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25 (10) 1862-1868
- 7 Metzger BE, Buchanan TA, Coustan DR. et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30 (Suppl. 02) S251-S260
- 8 Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14: 41
- 9 Hunt KJ, Logan SL, Conway DL, Korte JE. Postpartum screening following GDM: how well are we doing?. Curr Diab Rep 2010; 10 (03) 235-241
- 10 Hale NL, Probst JC, Liu J, Martin AB, Bennett KJ, Glover S. Postpartum screening for diabetes among Medicaid-eligible South Carolina women with gestational diabetes. Womens Health Issues 2012; 22 (02) e163-e169
- 11 Oza-Frank R. Postpartum diabetes testing among women with recent gestational diabetes mellitus: PRAMS 2009-2010. Matern Child Health J 2014; 18 (03) 729-736
- 12 Van Ryswyk E, Middleton P, Hague W, Crowther C. Clinician views and knowledge regarding healthcare provision in the postpartum period for women with recent gestational diabetes: a systematic review of qualitative/survey studies. Diabetes Res Clin Pract 2014; 106 (03) 401-411
- 13 Vesco KK, Dietz PM, Bulkley J. et al. A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. Am J Obstet Gynecol 2012; 207 (04) 283.e1-2 -83.e6
- 14 Edelson PK, James KE, Leong A. et al. Longitudinal changes in the relationship between hemoglobin a1c and glucose tolerance across pregnancy and postpartum. J Clin Endocrinol Metab 2020; 105 (05) e1999-e2007
- 15 Claesson R, Ekelund M, Ignell C, Berntorp K. Role of HbA1c in post-partum screening of women with gestational diabetes mellitus. J Clin Transl Endocrinol 2014; 2 (01) 21-25
- 16 Picón MJ, Murri M, Muñoz A, Fernández-García JC, Gomez-Huelgas R, Tinahones FJ. Hemoglobin A1c versus oral glucose tolerance test in postpartum diabetes screening. Diabetes Care 2012; 35 (08) 1648-1653
- 17 Katreddy MV, Pappachan JM, Taylor SE, Nevill AM, Indusekhar R, Nayak AU. Hemoglobin A1c in early postpartum screening of women with gestational diabetes. World J Diabetes 2013; 4 (03) 76-81
- 18 Liu X, Wu N, Al-Mureish A. A review on research progress in the application of glycosylated hemoglobin and glycated albumin in the screening and monitoring of gestational diabetes. Int J Gen Med 2021; 14: 1155-1165
- 19 Zendjabil M. Glycated albumin. Clin Chim Acta 2020; 502: 240-244
- 20 Dong Y, Zhai Y, Wang J. et al. Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes. BMC Pregnancy Childbirth 2020; 20 (01) 12
- 21 Kohzuma T, Koga M. Lucica GA-L glycated albumin assay kit: a new diagnostic test for diabetes mellitus. Mol Diagn Ther 2010; 14 (01) 49-51
- 22 Freitas PAC, Ehlert LR, Camargo JL, Freitas PAC, Ehlert LR, Camargo JL. Glycated albumin: a potential biomarker in diabetes. Arch Endocrinol Metab 2017; 61 (03) 296-304
- 23 Li HP, Wang FH, Tao MF, Huang YJ, Jia WP. Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus. J Diabetes Investig 2016; 7 (01) 48-55
- 24 Hashimoto K, Osugi T, Noguchi S. et al. A1C but not serum glycated albumin is elevated because of iron deficiency in late pregnancy in diabetic women. Diabetes Care 2010; 33 (03) 509-511
- 25 Koga M, Kasayama S. Clinical impact of glycated albumin as another glycemic control marker. Endocr J 2010; 57 (09) 751-762
- 26 Saglam B, Uysal S, Sozdinler S, Dogan OE, Onvural B. Diagnostic value of glycemic markers HbA1c, 1,5-anhydroglucitol and glycated albumin in evaluating gestational diabetes mellitus. Ther Adv Endocrinol Metab 2017; 8 (12) 161-167
- 27 Kurishita M, Nakashima K, Kozu H. Glycated hemoglobin of fractionated erythrocytes, glycated albumin, and plasma fructosamine during pregnancy. Am J Obstet Gynecol 1992; 167 (05) 1372-1378
- 28 Nathan DM, McGee P, Steffes MW, Lachin JM. DCCT/EDIC Research Group. Relationship of glycated albumin to blood glucose and HbA1c values and to retinopathy, nephropathy, and cardiovascular outcomes in the DCCT/EDIC study. Diabetes 2014; 63 (01) 282-290
- 29 Zhu J, Chen Y, Li C, Tao M, Teng Y. The diagnostic value of glycated albumin in gestational diabetes mellitus. J Endocrinol Invest 2018; 41 (01) 121-128
- 30 American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45 (Suppl. 01) S17-S38
- 31 Diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33 (03) 676-682
- 32 Sato A, Yada S, Hosoba E, Kanno H, Miura H. Establishment of glycated albumin unit conversion equation from the standardized value (mmol/mol) to the routinely used value (%). Ann Clin Biochem 2019; 56 (02) 204-209
- 33 Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med 2016; 9: 229-255
- 34 Bacq Y, Zarka O, Bréchot JF. et al. Liver function tests in normal pregnancy: a prospective study of 103 pregnant women and 103 matched controls. Hepatology 1996; 23 (05) 1030-1034
- 35 Honger PE. Albumin metabolism in normal pregnancy. Scand J Clin Lab Invest 1968; 21 (01) 3-9
- 36 Sugawara D, Sato H, Ichihashi K, Nagai K, Kawano A. Glycated albumin level during late pregnancy as a predictive factor for neonatal outcomes of women with diabetes. J Matern Fetal Neonatal Med 2018; 31 (15) 2007-2012
- 37 Hashimoto K, Koga M. Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus. World J Diabetes 2015; 6 (08) 1045-1056
- 38 Mendes N, Tavares Ribeiro R, Serrano F. Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus. J Obstet Gynaecol 2018; 38 (06) 762-769