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Hba1c In Third Trimester

Hba1c Monitoring In Gestational Diabetes (query Bank)

Hba1c Monitoring In Gestational Diabetes (query Bank)

Question Is there any place to monitor glycosylated hemoglobin (HbA1c) in pregnant women with gestational diabetes? Especially in relation to predicting fetal morbidity such as macrosomia/ shoulder dystocia? Answer This clinical query answer was produced by RCOG Library staff following the clinical query protocol. Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new clinical query. The NICE guideline on diabetes in pregnancy (National Collaborating Centre) recommends that HbA1c should not be used routinely for assessing glycaemic control in the second and third trimesters of pregnancy. The International Diabetes Foundation global guideline on pregnancy and diabetes makes the following recommendation for Management of gestational diabetes: “Do not use routine measurement of HbA1c for management” (Evidence level IV) A systematic review of antepartum A1C, maternal diabetes outcomes, and selected offspring outcomes (Katon, 2011) found A1C at gestational diabetes mellitus (GDM) diagnosis was positively associated with post-partum abnormal glucose. Women with post-partum T2DM or impaired glucose tolerance had mean A1C at GDM diagnosis higher than those with normal post-partum glucose (P <= 0.002) and a 1% increase in A1C at GDM diagnosis was associated with 2.36 times higher odds of post-partum abnormal glucose 6 weeks after delivery [95% confidence interval 1.19, 4.68]. The association of A1C and birthweight varied substantially between studies, with correlation coefficients ranging from 0.11 to 0.51. Other recently published studies have found conflicting relationships between HbA1c levels and infant outcomes, but some correlation with maternal outcomes: Katon et al (2012) rep Continue reading >>

Adverse Outcomes Up With High A1c In Late Pregnancy For Type 1 Women

Adverse Outcomes Up With High A1c In Late Pregnancy For Type 1 Women

An HbA1c of 6.5-6.9% at 26 weeks’ gestation correlated with significantly elevated risk of preterm delivery, preeclampsia, need for neonatal glucose infusion, and a composite adverse outcome… Michael J.A. Maresh, M.D., from St. Mary’s Hospital in Manchester, U.K., and colleagues conducted a prospective assessment involving 725 women with type 1 diabetes to examine the correlation between second and third trimester glycemic control and pregnancy outcomes. The women were categorized into five groups according to hemoglobin A1c (HbA1c) values at 26 and 34 weeks’ gestation, with the lowest value of The researchers found that an HbA1c of 6.0 to 6.4 percent at 26 weeks’ gestation correlated with increased risk of large for gestational age (odds ratio, 1.7) children. An HbA1c of 6.5 to 6.9 percent at 26 weeks’ gestation correlated with significantly elevated risk of preterm delivery, preeclampsia, need for neonatal glucose infusion, and a composite adverse outcome (odds ratios, 2.5, 4.3, 2.9, and 3.2, respectively). There was a progressive increase in these risks with increasing HbA1c. Similar results were seen at 34 weeks’ gestation. Less consistent trends were seen for the glucose profile. The researchers concluded that a continuous relationship was shown between multiple maternal and neonatal adverse outcomes and increasing A1C values in the second and third trimester of pregnancy in women with type 1 diabetes. These adverse outcomes were significantly associated with HbA1C of ≥6.5% (48mmol/mol) and LGA with an HbA1C ≥6.0% (42mmol/mol). They asserted that women should be advised to aim for target values of <6.5% (48mmol/mol) and ideally <6.0% (42mmol/mol) if this is possible without excessive hypoglycemia. If this goal is not achieved, additional surveilla Continue reading >>

Hba1c And Pregnancy

Hba1c And Pregnancy

Tweet Keeping blood sugar levels under control is hugely important for women who either have diabetes going into pregnancy or who develop diabetes during their pregnancy. Tight blood glucose control helps increase the chances of a successful pregnancy by cutting the risk of complications for your baby. If you have diabetes, one of the ways your doctor or nurse will monitor your glycemic control is by carrying out a HbA1c test. The HbA1c test measures glycated haemoglobin - a molecule within red blood cells that naturally bonds with glucose - to get a good indication of your average blood glucose over the past 8-12 weeks. This guide outlines when your HbA1c readings will be taken and what HbA1c values should be before (planning stage), during and after your pregnancy. Planning pregnancy The NICE guidelines for Diabetes in Pregnancy (Clinical Guideline 63) state that women with diabetes should aim to achieve an HbA1c result of 43 mmol/mol (6.1%) or lower. If you are planning to become pregnant, you should be offered an HbA1c measurement on a monthly basis to help monitor your blood glucose control. Meeting the target will help to minimise the risk of the baby developing risk of congenital malformations. If you have an HbA1c above 10%, it is strongly advised to avoid becoming pregnant until good diabetes control is achieved and sustained. During pregnancy During the first trimester of pregnancy, the HbA1c target for women with diabetes is the same as for planning a pregnancy, that is 43 mmol/mol (6.1%) or lower. During the second and third trimesters of pregnancy, from week 13 onwards, HbA1c should not be used for assessing blood glucose control. Throughout pregnancy, women with diabetes should aim to meet the following blood glucose targets Before meals: 3.5 to 5.9 mmol/l Continue reading >>

Associations Of Mid-pregnancy Hba1c With Gestational Diabetes And Risk Of Adverse Pregnancy Outcomes In High-risk Taiwanese Women

Associations Of Mid-pregnancy Hba1c With Gestational Diabetes And Risk Of Adverse Pregnancy Outcomes In High-risk Taiwanese Women

Abstract The objective of this study was to investigate the associations among the mid-pregnancy glycated hemoglobin A1c (HbA1c) level, gestational diabetes (GDM), and risk of adverse pregnancy outcomes in women without overt diabetes and with positive 50-g, 1-h glucose challenge test (GCT) results (140 mg/dL or greater). This prospective study enrolled 1,989 pregnant Taiwanese women. A two-step approach, including a 50-g, 1-h GCT and 100-g, 3-h oral glucose tolerance test (OGTT), was employed for the diagnosis of GDM at weeks 23–32. The mid-pregnancy HbA1c level was measured at the time the OGTT was performed. A receiver operating characteristic (ROC) curve was used to determine the relationship between the mid-pregnancy HbA1c level and GDM. Multiple logistic regression models were implemented to assess the relationships between the mid-pregnancy HbA1c level and adverse pregnancy outcomes. An ROC curve demonstrated that the optimal mid-pregnancy HbA1c cut-off point to predict GDM, as diagnosed by the Carpenter-Coustan criteria using a two-step approach, was 5.7%. The area under the ROC curve of the mid-pregnancy HbA1c level for GDM was 0.70. Compared with the levels of 4.5–4.9%, higher mid-pregnancy HbA1c levels (5.0–5.4, 5.5–5.9, 6.0–6.4, 6.5–6.9, and >7.0%) were significantly associated with increased risks of gestational hypertension or preeclampsia, preterm delivery, admission to the neonatal intensive care unit, low birth weight, and macrosomia (the odds ratio [OR] ranges were 1.20–9.98, 1.31–5.16, 0.88–3.15, 0.89–4.10, and 2.22–27.86, respectively). The mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in high-risk Taiwanese women. However, it lacked adequate sensitivity and specificity to replace the two-step Continue reading >>

Hba1c Level In Last Trimester Pregnancy In Predicting Macrosomia And Hypoglycemia In Neonate | S. | International Journal Of Contemporary Pediatrics

Hba1c Level In Last Trimester Pregnancy In Predicting Macrosomia And Hypoglycemia In Neonate | S. | International Journal Of Contemporary Pediatrics

HbA1c level in last trimester pregnancy in predicting macrosomia and hypoglycemia in neonate Subash S., Sathyamoorthy M., Prasanna R., Karthikeyan P., Sekar P., Ram Reddy Background:The usefulness of single value of HbAlc during last trimester in pregnancies complicated by diabetes either pre-existing or gestational diabetes in predicting macrosomia and neonatal hypoglycemia is investigated. The aim of the study was to anticipate and manage the difficult labor due to macrosomia and to monitor these high risk newborns closely for hypoglycemia thereby preventing the neonatal morbidity. Methods: A Prospective observational study of 96 mothers was done for a period of one year from June 2012 to September 2013 in a tertiary care centre. HbAlc level was estimated as one time blood test in the last trimester of pregnancy. At delivery anthropometric measurements of the baby were recorded and an intra-uterine growth chart was used to check whether the baby is macrosomic or not. Any difficult or non-progression of labor and ceaserian section details are recorded. Macrosomia is birth weight more than 90th percentile for the gestational age. Hypoglycemia occurs when blood sugar level found to be <40 mg/dl at 3 hours of life. Chi square test is used to see the correlation between HbAlC and macrosomia and hypoglycemia. Results:20 babies had macrosomia and 22.9% of them had hypoglycemia. HbAlc <5.7 is defined as normal and HbAlc > 5.7% as abnormal. Mothers with abnormal HbAlc levels had a statistically significant correlation (P <0.001) to occurrence of Macrosomia and hypoglycemia in babies. Conclusions:An abnormal HbAlc in third trimester in pregnancies complicated by diabetes can predict Macrosomia and hypoglycemia in the neonates. HbA1c level, Hypoglycemia, Macrosomia, Pregnancy M Continue reading >>

Hba1c Levels Are Significantly Lower In Early And Late Pregnancy

Hba1c Levels Are Significantly Lower In Early And Late Pregnancy

sparsely investigated with different meth- (5,6,11,12), and reference ranges are gen- All subjects had a random capillary blood based on risk factors for gestational dia- Department of Endocrinology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Steno Diabetes Center, Copenhagen, Denmark; and the Odense University Hospital, Odense, Denmark. Address correspondence and reprint requests to Elisabeth Mathiesen, Department of Endocrinology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E- Received for publication 19 January 2004 and accepted in revised form 20 January 2004. C.G. holds stocks in and receives grant support from Novo Nordisk. Abbreviations: DCCT, Diabetes Control and Complications Trial; OGTT, oral glucose tolerance test. 2004 by the American Diabetes Association. 1200 DIABETES CARE, VOLUME 27, NUMBER 5, MAY 2004 OKane et al. (6), who studied 493 healthy Hartland et al. (5), who investigated 267 in these two studies. Our study included a tolerance test. This might explain why we 10, and is sustained during the remaining level was not measured in this study, and the third trimester of pregnancy, indicat- wide study in the Netherlands. Diabetolo- pre-eclampsia in type I diabetes. Diabeto- type 1 diabetes mellitus: a major potential factor underlying macrosomia (Editorial). 5. Hartland AJ, Smith JM, Clark PMS, Web- trol and complications trial-aligned HbA1c 7. Kilpatrick ES: Glycated haemoglobin in 8. Marshall SM, Barth JH: Standardization of 9. American Diabetes Association: Precon- 10. Worth R, Potter JM, Drury J, Fraser RB, globins. Br J Obstet Gynaecol 86:210213, Glycaemic control is associated with pre- te Continue reading >>

Glycosylated Haemoglobin For Screening And Diagnosis Of Gestational Diabetes Mellitus

Glycosylated Haemoglobin For Screening And Diagnosis Of Gestational Diabetes Mellitus

Abstract Objectives The oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the most accepted measure of chronic glycaemia outside of pregnancy. HbA1c is an uncomplicated test, less time consuming, does not require any specific patient preparation and is considered straightforward compared with the OGTT. Therefore, we prospectively tested the utility of the HbA1c when used as a screening tool in pregnancy for gestational diabetes mellitus (GDM). Settings Primary health care. Single tertiary referral centre, Tasmania, Australia. Participants A direct comparison between HbA1c levels and the OGTT results in pregnant women, tested concurrently at the 24–28 gestational week, was undertaken. A full profile of 480 pregnant women during the period from September 2012 to July 2014 was completed. Median and mean age of participants was 29 years (range 18–47 years). Interventions A simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed. Results The number of women who had GDM according to OGTT criteria was 57, representing 11.9% of the evaluated 480 pregnant women. Using a cut-off value for HbA1c at 5.1% (32 mmol/mol) for detecting GDM showed sensitivity of 61% and specificity of 68% with negative predictive value (NPV) of 93%, versus sensitivity of 27% and specificity of 95% with NPV of 91% when using HbA1c cut-off value of 5.4% (36 mmol/mol). Conclusions Our results suggest that pregnant women with an HbA1c of≥5.4% (36 mmol/mol) should proceed with an OGTT. This may result in a significant reduction in the burden of testing on both patients and t Continue reading >>

Hba1c Level In 2nd And 3rd Trimester With Pregnancy Outcome In Diabetic Patients

Hba1c Level In 2nd And 3rd Trimester With Pregnancy Outcome In Diabetic Patients

HbA1C Level in 2nd and 3rd Trimester with Pregnancy Outcome in Diabetic Patients Ruma Sengupta, Soha Jesmen, laila Arjuman Banu, Samir Humyra Habib Objective: The present study was undertaken to determine the association of maternal serum HbA1C level with maternal and fetal outcome. Materials and Methods: It was prospective observational study. The study was carried out in the department of Obstetrics and Gynaecology in BIRDEM Hospital during the period of September 2006 to August 2007. During this study period, 100 pregnant patient with diabetes who attended or admitted at BIRDEM Hospital were studied. Estimation of serum HbA1C level was done in all patient in each trimester. From each patient 5 c.c blood was taken & HbA1C level was measured with the help of enzymatic method. HbA1C level < 6 was considered as normal. .The maternal complications in antenatal period, in postpartum period, during labour & fetal outcome were studied in both cases of controlled & uncontrolled HbA1C level. Result: In this study serum HbA1C level was found raised in uncontrolled diabetic patients. The incidence of vulvovaginitis, preterm delivery and polyhydramnios were significantly high in 2nd and 3rd trimester in raised HbA1C level. The rate of normal vaginal delivery was higher in patient with normal HbA1C leve uncontrolled HbA1C level (17.59% Vs 10.84%, p = 0.01), which statistically significant. Post partum haemorrhage (PPH) was significantly higher in raised HbA1C level than normal (0.00% Vs 22.20%, p =0.01) in NVD and (0.00% Vs 16.22%, p = 0.01) in Caesarean section. Neonatal complications were higher in raised HbA1C level than normal. The incidence of Hypoglycemia (5.88% Vs 38.55%, p = 0.02); Hyperbilirubinemia (11.76% Vs 33.73%, p = 0.03) ; RDS (0.00% Vs 12.05%, p = 0.02); Macrosom Continue reading >>

Application Of Glycated Hemoglobin In The Perinatal Period

Application Of Glycated Hemoglobin In The Perinatal Period

Glycated hemoglobin (HbA1c) is a special fragment formed by the binding of glucose to the C chain or D chain of hemoglobin A and as a result of non-enzymatic catalysis of mature hemoglobin and glucose, which is an indicator used to evaluate the blood glucose control in diabetes mellitus (DM) patients. Recent researches indicated that HbA1c could be applied in gestational diabetes mellitus (GDM) and pregnancy combined DM, and increasing of HbA1c was close associated with adverse outcomes of women with pregnancy combined DM and GDM. HbA1c was reported to have a significant importance in monitoring congenital malformation, abortion, perinatal mortality, preeclampsia, postpartum abnormal glucose metabolism, vascular complications and so on, which could be a test item during the second trimester. Sensitivity of HbA1c in diagnoses of DM is lower than oral glucose tolerance test (OGTT), thus OGTT is still the golden standard of GDM. Emphasis should be put on standardization of detection and threshold of HbA1c and establishment of HbA1c normal ranges of different trimesters, when HbA1c is used to diagnose pregnancy combined DM and GDM, and evaluate effects of treatments. The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Application of glycated hemoglobin in the perinatal period. Int J Clin Exp Med. 2014; 7(12): 46534659. Haiyan Yu , Xiaorong Qi , and Xiaodong Wang Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China Address correspondence to: Dr. Xiaodong Wang, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, 20 Section 3, South Ren Continue reading >>

Hba1c Levels Are Significantly Lower In Early And Late Pregnancy

Hba1c Levels Are Significantly Lower In Early And Late Pregnancy

Strict glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by diabetes (1–3). In addition to home blood glucose measurement, which may not always reflect the true average blood glucose level (4), HbA1c is a useful parameter in metabolic regulation (5–8). Thus, supplementation with HbA1c, as is common outside pregnancy, seems appropriate. Before pregnancy, the target for metabolic control in women with diabetes is HbA1c values near the normal range (9). However, the upper normal range of HbA1c during normal pregnancy is only sparsely investigated with different methods (10), mainly in late pregnancy (5,6,11,12), and reference ranges are generally established from the nonpregnant state (4). Increased third-trimester HbA1c levels are associated with an increased risk of preeclampsia (3,13), macrosomia (1), and stillbirth (2), leading to speculations that the target for HbA1c in pregnancy should be even lower than outside pregnancy to prevent adverse events. There is a need to establish the reference range of HbA1c during normal pregnancy with an internationally recognized Diabetes Control and Complications Trial (DCCT)-aligned method. In this study, we evaluated the normal upper range of HbA1c in early and late pregnancy. RESEARCH DESIGN AND METHODS From our antenatal clinic, we randomly selected 100 healthy pregnant women without previous gestational diabetes (early pregnancy group). All subjects had a random capillary blood glucose level <7.0 mmol/l at their first antenatal visit at approximately week 14 (range 8–17), and none developed gestational diabetes. A selective screening based on risk factors for gestational diabetes was used (14). A late pregnancy group was established of 98 h Continue reading >>

What Are The Target Blood Sugar Levels During The Second And Third Trimester Of Pregnancy For Women With Type 1 Diabetes?

What Are The Target Blood Sugar Levels During The Second And Third Trimester Of Pregnancy For Women With Type 1 Diabetes?

This study investigated blood glucose control in the second and third trimesters and pregnancy outcomes in women with type 1 diabetes. The authors concluded that regular testing of average blood glucose levels could be beneficial, as higher levels were associated with adverse outcomes. Patients with type 1 diabetes (T1D) do produce enough insulin (the hormone needed to break down the glucose taken in from food. During pregnancy, women with uncontrolled blood sugar levels are at a higher risk of adverse outcomes for both mother and baby. Larger newborn size is one possible outcome. Excessively large babies, for example, can have an increased risk of obesity and diabetes. It is currently recommended that women try to achieve HbA1c levels (average blood glucose over 3 months) under 6% during the first trimester. It is not clear whether this should be the same target in the second or third trimesters. This study included 725 pregnant women with T1D. HbA1c levels were measured at 26 and 34 weeks. Patients were followed to determine the outcomes of both the mother and the baby following birth. At 26 weeks of pregnancy, patients with an HbA1c between 6.0% and 6.4% were 70% more likely to have babies who were large at birth. Patients with levels between 6.5 and 6.9% at 26 weeks were over twice as likely to give birth prematurely, to have a baby requiring sugar infusion at birth, or a combination of other adverse outcomes. These results were similar forHbA1c at 34 weeks. This study concluded that higher HbA1c levels during the second and third trimesters were associated with an increased risk of adverse outcomes. The authors suggested that it was worthwhile for women with T1D to undergo regular HbA1c measurements. Patients must balance their blood sugar control with the preventi Continue reading >>

Original Research Hba1c As A Predictor Of Diabetes After Gestational Diabetes Mellitus

Original Research Hba1c As A Predictor Of Diabetes After Gestational Diabetes Mellitus

Highlights • Third-trimester HbA1c was investigated as a predictor of diabetes following GDM. • After five years, 73/196 (37%) of the women had developed diabetes. • HbA1c ≥36 mmol/mol (≥5.4%) was associated with a 5.5-fold increased risk of diabetes. • HbA1c showed high specificity but low sensitivity to predict diabetes post-partum. • HbA1c could be used as a means of selecting high-risk women for interventions. Abstract We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM. Continue reading >>

Pregnancy With Diabetes

Pregnancy With Diabetes

A Doable Challenge Women with Type 1 or Type 2 diabetes who are considering pregnancy have reason to feel optimistic. That’s because women with diabetes can and do experience healthy, uneventful pregnancies and give birth to perfectly healthy babies. That said, however, a pregnancy with preexisting diabetes is always considered high-risk, and its outcome is largely dependent on a woman’s efforts to keep her blood glucose levels as close to the normal range as possible for the entire duration of her pregnancy. The American Diabetes Association recommends blood glucose goals for pregnant women that are lower than those suggested for the general population: 60–99 mg/dl before meals and 100–129 mg/dl one hour after eating. Anyone with diabetes knows that staying in that range every day for nine months requires tremendous commitment, even when not pregnant. Achieving those goals while pregnancy hormones are wreaking havoc with your insulin needs and while your whole body is growing and changing is another thing altogether. Add morning sickness, exhaustion, swollen ankles, and normal pregnancy anticipation into the mix, and you have a full bag of stress triggers. So how does a pregnant woman with diabetes manage to keep herself and her baby healthy while also balancing her usual family, work, and other life responsibilities? This article offers strategies based on experiences from my own two pregnancies as well as those from other women with diabetes who have made the effort to do all that was in their power to bring healthy children into the world. (Note: This article focuses on women with existing Type 1 or 2 diabetes before pregnancy rather than women who develop gestational diabetes during pregnancy). Pregnancy preparation When I first mentioned wanting to have a Continue reading >>

Glucose Fluctuations During Gestation: An Additional Tool For Monitoring Pregnancy Complicated By Diabetes

Glucose Fluctuations During Gestation: An Additional Tool For Monitoring Pregnancy Complicated By Diabetes

Glucose Fluctuations during Gestation: An Additional Tool for Monitoring Pregnancy Complicated by Diabetes M. G. Dalfr ,1 N. C. Chilelli ,1 G. Di Cianni ,2 G. Mello ,3 C. Lencioni ,2 S. Biagioni ,3 M. Scalese ,4 G. Sartore ,1and A. Lapolla 1 1Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy 2Department of Endocrinology & Metabolism, Section of Metabolic Diseases & Diabetes, AOUP Pisa, University of Pisa, Ospedale Cisanello, Via Paradisa no. 2, 56124 Pisa, Italy 3Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Viale Giovan Battista Morgagni no. 85, 50134 Florence, Italy 4CNR, Institute of Clinical Physiology, Via G. Moruzzi no. 1, 56124 Pisa, Italy Received 20 May 2013; Revised 19 September 2013; Accepted 30 September 2013 Copyright 2013 M. G. Dalfr et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycem Continue reading >>

Glycosylated Hemoglobin Values In Nondiabetic Pregnant Women In The Third Trimester And Adverse Fetal Outcomes: An Observational Study

Glycosylated Hemoglobin Values In Nondiabetic Pregnant Women In The Third Trimester And Adverse Fetal Outcomes: An Observational Study

Glycosylated hemoglobin values in nondiabetic pregnant women in the third trimester and adverse fetal outcomes: An observational study 1Lakeshore Hospital and Research Centre, Kochi, Kerala, India Address for correspondence: Dr. P. Shobha, Kappillil Sanjeevani, Residents Lane, Edappally P.O., Kochi - 682 024, Kerala, India. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : Journal of Family Medicine and Primary Care This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. The objective of the study is to estimate the level of glycosylated hemoglobin (HbA1c) for a safe fetal outcome and to estimate the relation between this level and various adverse fetal outcomes. Materials and Primigravidas who are diagnosed as not having gestational diabetes mellitus as per the glucose challenge test done at 24 weeks with a cutoff value up to 140 mg/dl are followed up at 3034 weeks for the estimation of HbA1c in the blood and further till the time of delivery and postnatal period for the fetal outcomes. Data were collected based on detailed patient interview, clinical examination, and laboratory investigations. Data were analyzed to obtain the mean value of HbA1c in the third trimester. Fetal outcomes were analyzed with the HbA1c value using Chi-square test. The HbA1c values in the third trimester of pregnancy in this study ranged from 4.5% to 6%. Unfavorable outcomes were found the least in the 4.5%5%. The average plasma blood glucose corresponding to HbA1c value of 5% is 101 mg/dl. Continue reading >>

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