Glycated albumin levels in the third trimester of women with gestational diabetes mellitus are associated with adverse pregnancy-related outcomes

Abstract

Background Glycated albumin (GA) levels have been considered as a promising biomarker for estimating glycemic control during pregnancy, but the relationship between GA levels and the incidence of adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains unclear. Our study aimed to investigate the relationship between GA levels during the third trimester and 13 different adverse pregnancy-related outcomes among women with GDM in China. Methods We retrospectively extracted clinical data from the medical records of 819 pregnant women with GDM who underwent prenatal examinations and child delivery at the Affiliated Hospital of Qingdao University between January 2022 and October 2022. The cohort was divided into GA-high (GA-H) and GA-low (GA-L) groups based on the median GA level of 10.6%. Then, the incidence rates of 13 specific adverse pregnancy outcomes were compared between the two groups. Furthermore, we estimated the mean GA levels in pregnant GDM women with or without specific adverse outcomes. Multivariate logistic regression analysis was performed to assess whether the GA levels (high or low) were independent risk factors for specific adverse outcomes in pregnant women with GDM. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of GA levels for the adverse pregnant outcomes in women with GDM. E-value for sensitivity analysis was performed to assess the robustness of the findings to unmeasured confoundings. Results We included 819 pregnant women with GDM, whose average age was 33.09 +/- 4.47 years, average pre-pregnancy BMI was 23.51 +/- 3.67 kg/m2, and the average gestational week in which GDM diagnosed was 24.80 +/- 1.79 weeks. The analysis showed that 80.71% (661/819) pregnant women with GDM were associated with adverse pregnancy-related outcomes. Pregnant women in the GA-L group showed higher incidence of the premature rupture of membranes (PROM), whereas those in the GA-H group showed higher incidence of neonatal hypoglycemia. The GA levels showed acceptable clinical performance for predicting neonatal hypoglycemia with an area under the ROC curve (AUC) value of 0.700 (P = 0.010), sensitivity of 71.4%, and specificity of 70.2%. The optimal cut off value for GA was 11.55%. Conclusions This study demonstrated that GA levels were significantly associated with specific adverse pregnancy outcomes, especially PROM and neonatal hypoglycemia. Furthermore, GA levels in the third trimester showed acceptable clinical performance for predicting neonatal hypoglycemia among pregnant women with GDM. In the future, the potential role of GA as a predictor of adverse pregnancy outcomes need to be further confirmed and explored in GDM women.