Glycated albumin may be used as preliminary test for gestational diabetes mellitus, suggests study
The number of young women of childbearing age diagnosed with
Type II diabetes mellitus has increased globally, and many more women will
present with hyperglycemia first identified in pregnancy. There is a global
rise in the prevalence of gestational diabetes mellitus (GDM). Over 80% of
women with hyperglycemia in pregnancy have GDM. Hyperglycemia first identified
in pregnancy can be classified as either GDM or diabetes mellitus in pregnancy.
Gestational diabetes mellitus is defined as different levels of glucose
intolerance first identified in pregnancy. The diagnosis of GDM is made when
hyperglycemia first detected in pregnancy does not meet the criteria for the
diagnosis of diabetes mellitus in the non-pregnant state: Gestational diabetes
mellitus is fasting plasma glucose (FPG) value between 5.1 to 6.9 mmol/L, or
one-hour 75g oral glucose tolerance test (OGTT) of10.0mmol/l or more, or
two-hour 75g OGTT value between 8.5 to 11.1mmol/L. The prevalence of GDM varies
from country to country and
The babies of women with GDM may be premature, growth-restricted,
or large-for-date. They may suddenly die in utero or have birth injuries from
shoulder dystocia and instrumental delivery. These babies may be admitted into
the special care baby unit for hyperglycemia, hypoglycemia, hyperbilirubinemia,
electrolyte imbalance, necrotizing enterocolitis, intra-ventricular hemorrhage,
or respiratory distress syndrome.
The morbidities associated with GDM can be significantly
reduced if the women are diagnosed with GDM early and appropriate treatment is
instituted. The Oral glucose tolerance test is the gold standard for GDM
screening in pregnant women. The OGTT requires a stable carbohydrate diet for
about three days and an overnight fast of at least eight hours. The OGTT is
also affected by medications, acute illness, exercise, and stress. Most women
do not meet these pre-analytical conditions before they are screened for GDM
using the OGTT. The OGTT procedure requires drinking a glucose solution that
may cause nausea and vomiting and also requires multiple sample collections. Therefore,
the OGTT procedure is cumbersome.
Glycated albumin is formed when albumin undergoes a
nonenzymatic glycation reaction with blood sugar. Unlike OGTT which can be
affected by fasting and type of food, glycated albumin is not affected by
fasting or type of carbohydrate intake. The half-life of glycated albumin is
about 20 days, therefore can be used to assess glycemic control for up to three
weeks with a single sample collection irrespective of fasting or type of food
eaten by the woman. Glycated albumin concentration in plasma is not affected by
iron deficiency anemia, sickle cell disease, and sickle cell disease traits, however,
it can be affected by disease conditions that affect albumin metabolism, age,
and body mass index. Glycated albumin is also affected by ethnicity and race.
Black Americans have higher glycated albumin levels than Caucasians.
The study involved 200 pregnant women attending the
antenatal clinic at the University of Port Harcourt Teaching Hospital. The
diagnosis of gestational diabetes mellitus was made using the World Health
Organization 2013 diagnostic criteria. The test characteristics of glycated
albumin were determined using the area under the curve of the receiver operator
characteristic curve, sensitivity, specificity, positive predictive value, and
negative predictive value.
The prevalence of gestational diabetes mellitus was 9.0%.
The area under the receiver operator characteristic curve for glycated albumin
was 0.8 (95% CI 0.7-0.9; p=0.0001). The sensitivity and specificity of glycated
albumin were 83.3% and 86.8% respectively. The positive predictive value was
38.5% and the negative predictive value was 98.1%.
The prevalence of GDM in this study is 9.0% which is higher
than the values reported in a systematic review and meta-analysis of other
studies in Africa. Glycated albumin measured between 24 to 28 weeks of
gestation at a diagnostic cut-off value of 19% has a sensitivity of 83.3%, a
specificity of 86.8%, a positive predictive value of 38.5%, and a negative predictive
value of 98.1%. Therefore, can be used as a preliminary test in determining who
will be screened for GDM using OGTT.
Source: Woruka et al. / Indian Journal of Obstetrics and
Gynecology Research 2024;11(2):281–286
https://doi.org/10.18231/j.ijogr.2024.054
