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First Trimester Maternal Glycated Hemoglobin and Sex Hormone-Binding Globulin Do Not Predict Third Trimester Glucose Intolerance of Pregnancy

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Abstract

Early pregnancy prediction of third trimester glucose intolerance may identify a population of women whose trajectory toward gestational diabetes mellitus (GDM) is modifiable. We assessed whether first trimester glycated hemoglobin (HbA1c) and sex hormone-binding globulin (SHBG), markers of insulin resistance, predicted third trimester glucose intolerance. Nondiabetic women with singleton pregnancies enrolled in a prospective observational study, 11 0/7 to 14 6/7 weeks. At enrollment, maternal characteristics, medical history, and blood samples were collected for HbA1c and SHBG. Two-step GDM screening was performed, 22 0/7 to 33 6/7 weeks. A 50 g oral glucose tolerance test ≥ 130 mg/dL defined screen positive, or glucose intolerance. Carpenter-Coustan criteria diagnosed GDM. Means HbA1c and SHBG were compared between glucose-intolerant versus normoglycemic women, and GDM versus no GDM women. We report unadjusted and adjusted odds ratios (OR; 95% confidence interval [CI]) of regression analyses. Adjusted models include race, enrollment body mass index, and history of GDM. Among 250 women, 29% were glucose intolerant and 6% had GDM. Among glucose-intolerant women, HbA1c was higher (5.3 ± 0.3 vs. 5.1 ± 0.3, P = .01) and associated with glucose intolerance in unadjusted, but not adjusted, models (OR: 2.9, 95% CI: 1.2–7.1; adjusted odds ratio [aOR]: 2.0, 95% CI: 0.7–5.4). Among GDM women, HbA1c was higher (5.4 ± 0.4 vs 5.2 ± 0.3, P = .002) and SHBG was lower (228 ± 72 vs 288 ± 93 mmol/L, P = .02). The HbA1c predicted GDM in unadjusted (OR: 13.2,95% CI: 2.6–68.0) but not adjusted (aOR: 6.7, 95% CI: 0.8–55.2) models. Although metabolic alterations may well precede third trimester glucose intolerance, neither HbA1c of SHBG remained an independent predictor of glucose intolerance or GDM in adjusted models.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Thomas Jefferson University School of Medicine, Philadelphia, PA, USA

    Erica K. Berggren MD

  2. Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Center for Reproductive Health, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Erica K. Berggren MD

  3. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Kim A. Boggess MD

  4. Department of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Leny Mathew MS & Jennifer Culhane PhD

Authors
  1. Erica K. Berggren MD
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  2. Kim A. Boggess MD
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  3. Leny Mathew MS
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  4. Jennifer Culhane PhD
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Correspondence to Erica K. Berggren MD.

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Berggren, E.K., Boggess, K.A., Mathew, L. et al. First Trimester Maternal Glycated Hemoglobin and Sex Hormone-Binding Globulin Do Not Predict Third Trimester Glucose Intolerance of Pregnancy. Reprod. Sci. 24, 613–618 (2017). https://doi.org/10.1177/1933719116667230

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  • DOI: https://doi.org/10.1177/1933719116667230

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