The Clinical Study Of Serum Glycatedalbumin In Normal Pregnant Women And Patients With Gestational Diabetes Mellitus

Part I. The clinical study of serum glycated albumin in normalpregnancy womenObjective To set up the reference value of serum glycated albumin(GA)inpregnancy for using in clinical practice through a clinical trial of normal pregnant women,and to discuss the influencing factors and trends．Methods1479normal pregnant womenwho presented to obstetric clinics of Shanghai Jiao Tong University Affiliated SixthPeople’s Hospital between December1,2010and February28,2014were studied withprospective study, using the method of percentiles to establish the reference range of GAfor normal prepregnancy body mass index (BMI) and weight gain within the normal rangeof769cases and using t test, multiple linear regression analysis method to study theinfluential factors and change trend. Results （1）GA value was negative correlation withprepregnancy BMI and positive correlation with glucose in the1479normal pregnantwomen((P<0.05); there is no obvious correlation between GA and age，birth weight andgravidity and parity (P>0.05),but GA is negative correlation with weight gain duringpregnancy; Multiples stepwise regression analysis showed that prepregnancy BMI andFPG were the main influential factors of GA in12～16,24～28and36～38weeks ofgestation.（2）When dividing1479subjects by prepregnancy BMI into3groups, low bodymass index group，normal body mass index group， and overweight and obesity group，respectively，we came to the following results：there was significant difference in the GAlevels among the3groups(P<0.05) in12～16,24～28and36～38weeks of gestation.Inaddition, GA values were statistically difference during pregnancy (P <0.05)（.3）The levelof GA in the2.5th to97.5th percentile was9.20％～14.70％of the769normal pregnantwomen with normal body mass index and weight gain within the normal range;10.53％～ 15.46%in12～16weeks of gestation;9.84％～13.96%in24～28weeks of gestation and8.94％～13.26%in36～38weeks of gestation, respectively．Conclusion With the growth of progestational body mass index and the progress ofthe pregnancy, GA gradually reduced, and is affected by weight gain during pregnancy. GAhas good correlation with glucose, it can reflect the blood glucose levels and be used as agood indicator of the blood glucose monitoring during pregnancy. The normal range of GAfor the pregnant women could be suggested at9.20%～14.70%． Part Ⅱ The Clinical Study of Serum Glycated Albumin inPatients with Gestational Diabetes MellitusAim To explore the clinical significance in gestational diabetes mellitus and analysethe correlation between GA and metabolic parameters, neonatal weight and others.Methods Using the liquid enzymatic method to determine the GA value of the639gestational diabetes mellitus women and1479normal pregnant women in12～14,24～28and36～38weeks of gestation, and then calculating the interrelated indexes, whopresented to obstetric clinics of Shanghai Jiao Tong University Affiliated Sixth People’sHospital between December1,2010and February28,2014through the prospective study.Results (1) Compared with normal group, the GA levels of GDM group increasedsignificantly at24to28weeks of gestation and36to38weeks of gestation in GDMgroup, the difference has statistical difference (p <0.05).(2) Pearson correlation analysisshowed that GA value，in12～16weeks of gestation, was negative correlation withprepregnancy BMI （r=-0.231， P=0.000） and positive correlation with FPG(r=0.135,P=0.011). There was no obvious correlation between GA and age, gravidity andparity (P>0.05). In24～28weeks of gestation GA was positive correlation with OGTTFPG,1hPG,2hPG, glucose abnormalities condition and birth weight (P<0.05), GA wasnegative correlation with HOMA-β,△I30/△G30, weight gain in24～28weeks ofgestation, but there was no correlation between GA and propregnancy BMI, HOMA-IR.GA was positive correlation with FPG, birth weight and blood glucose controlled situation,and was negative correlation with weight gain in36～38weeks of gestation and BMIbefore delivery. Multiples stepwise regression analysis showed that prepregnancy BMI andFPG is the main influential factors of GA in12～16weeks of gestation, OGTT FPG2hPGand△130／△G30in24～28weeks of gestation, FPG, birth weight, blood glucosecontrolled situation,weight gain and BMI before delivery in36～38weeks of gestation.(3)Based on OGTT diagnosis standard of GDM, we plotted the participants workcharacteristic curve (ROC). The area under curve of the GA to GDM diagnosis was0.581 (95%C.I;0.545～0.618), p=0.000). When GA≥12.30%was set as the tangent point ofGDM diagnosis the sensitivit was39.26%, and the specificity was73.68%;GA≥14.00%the sensitivity is9.13%, and the specificity was96.87%.(4) In gestationaldiabetes mellitus patients, GA showed a significant positive correlation with neonatalweight in24～28and35～38weeks of gestation. When GA≥13.00%had a higher riskfor overweight baby (≥3500g) in24～28weeks, GA≥14.00%and GA≥12.00%formacrosomia (≥4000g) in24～28and36～38weeks of gestation respectively. While, inthe high GA group of GDM patients, the incidence of caesarean section, premature ruptureof membranes, postpartum hemorrhage was higher than that in the low GA group.Conclusion In GDM patients, GA can accurately reflect the average blood glucose levelsand changes in the short term. GA≥11.60%can be used as a adequate and convenientdetection indicator for judgeing the poor blood glucose control in third trimester. But GAcan not be recommended for a diagnosis index of GDM.GA is closely related to the occurrence of macrosomia in second and third trimester ofGDM patients, and it can provide a basis for clinical treatment.