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Kim, Lee, and Kim: Usefulness of Glycated Albumin Levels in Predicting the Maternal or Neonatal Complications of Gestational Diabetes Mellitus during Late Pregnancy in South Korea: A Retrospective Study

Abstract

Background

Gestational diabetes can lead to complications in pregnant women and neonates. Maternal glycated albumin levels during late pregnancy may help predict complications in both mothers and neonates.

Methods

This study was conducted in 120 singleton pregnant women diagnosed with gestational diabetes who visited Trinium Woman’s Hostipal between July 1, 2020, and June 30, 2022. In this study, the patients’ medical records were retrospectively analyzed. Gestational diabetes was diagnosed using a two-step testing method, and glycated albumin tests were performed during the third trimester of pregnancy. The optimal cutoff value of glycated albumin for predicting maternal complications during pregnancy and neonatal complications was determined using the receiver operating characteristic curve.

Results

A total of 45 patients developed maternal complications, with cesarean section (39 patients) due to fetal cephalopelvic disproportion being the most common. As for the neonatal complications, eight neonates were macrosomic or overweight, while 15 neonates required neonatal intensive care unit admission. Additionally, 13 patients had concurrent complications affecting both the mother and neonate. The glycated albumin level in patients with complications was 12.87%, which was significantly higher than that in patients without complications (glycated albumin, 11.67%) (P<0.001). The optimal cutoff value of glycated albumin for predicting maternal and neonatal complications was 12.45%. The sensitivity, specificity, and Youden index were 66.7 %, 86.7%, and 0.534, respectively.

Conclusion

The third trimester glycated albumin test in mothers with gestational diabetes provides limited predictive value for maternal and neonatal complications.

INTRODUCTION

Gestational diabetes mellitus (GDM) occurs during pregnancy in women who have not been previously diagnosed with diabetes [1]. The global prevalence of GDM is approximately 14.7%, with a reported prevalence of 11.5% in Asia [2,3]. In South Korea, data from the National Health Insurance Service between 2011 and 2015 indicated an increasing trend in GDM cases annually, with an overall prevalence of 12.7% [4]. GDM arises from changes in maternal insulin sensitivity during pregnancy and fetal development. Elevated and altered levels of hormones, such as estrogen, progesterone, leptin, and cortisol, during pregnancy can lead to insulin resistance [5]. Consequently, blood sugar levels may increase during pregnancy, causing mothers without blood sugar-related issues to develop GDM before pregnancy.
GDM is a significant complication during pregnancy, and pregnant women with GDM may experience various complications such as preterm birth, preeclampsia (PE), and a higher likelihood of surgical delivery. Additionally, the risk of developing type 2 diabetes after childbirth is high [6,7]. Infants affected by GDM are at a higher risk of being born with macrosomia, being overweight, and developing conditions such as hypoglycemia and transient tachypnea after birth [8,9]. Therefore, appropriate blood glucose management during pregnancy is crucial for ensuring the safety of the mother and baby and preventing other complications.
Since 2020, the glycated albumin (GA) test has been covered by insurance, and the GA level has been used as a blood glucose-related indicator of pregnancy. GA refers to the structure formed by the nonenzymatic reaction of glucose with albumin. In simple terms, it refers to albumin formed upon glycation, a process where glucose binds to albumin. Compared with hemoglobin A1c (HbA1c), GA has a shorter half-life, thus reflecting the recent changes in blood glucose levels; the normal range for GA is typically 11%–16% [10]. However, to date, no specific results are available for Koreans during pregnancy, and only a few studies have investigated the different maternal and neonatal complications.
Therefore, this study aimed to investigate whether the GA test results in pregnant women with GDM could help predict the occurrence of complications in both mothers and neonates.

METHODS

1. Sample Size Selection, Participants, and Ethical Approval

To achieve a high-quality area under the receiver operating characteristic (ROC) curve (AUC) of >0.8, the sample size was determined to be larger than the number recommended by the guidelines [11]. From July 1, 2020, to June 30, 2022, 196 individuals were diagnosed with GDM at Trinium Woman’s Hostipal. Among them, 76 were excluded from the study, including those who were diagnosed with type 1 or type 2 diabetes before pregnancy, those taking medications for thyroid disease or hypertension, those with twin pregnancies, those diagnosed with breast cancer, foreigners, and individuals who were lost to follow-up. Finally, only 120 eligible participants were included in this study (Figure 1). This number of participants exceeded the originally planned number. All patients were diagnosed with GDM and underwent medical nutritional therapy, exercise therapy, and lifestyle modification, according to the guidelines of the Korean Diabetes Association, carried out by the same physician during their first outpatient visit [12].
This study was conducted using a retrospective research method based on the patient’s medical records. The collection of medical record data commenced only after obtaining approval (August 8, 2022) from the Research Ethics Review Committee. The requirement for obtaining informed consent was waived by the Institutional Review Board of Chungnam National University Sejong Hospital in South Korea (approval no., 2022-07-021). The study adhered to the principles of the Declaration of Helsinki. None of the authors had access to information that could identify the participants during or after data collection.

2. Definition

1) Diagnosis of GDM and measurement methods of GA and HbA1c

GDM was diagnosed using a two-step method in pregnant women at 24–28 weeks of gestation who had not been previously diagnosed with type 1 or type 2 diabetes. The process began by conducting a 50-g glucose challenge test (50 g GCT). Pregnant women with a glucose level of 140 mg/dL or higher were then subjected to a 100-g oral glucose tolerance test (100 g OGTT) after fasting for at least 8 hours. In the 100 g OGTT, the blood glucose levels were measured at fasting (<95 mg/dL), 1 hour (<180 mg/dL), 2 hours (<155 mg/dL), and 3 hours (<140 mg/dL) after oral glucose intake [13]. If the results of two or more of these four measurements exceeded the predetermined criteria, the patient was diagnosed with gestational diabetes.
Blood glucose tests were performed using the oxidase-peroxidase (GOD-POD) method (BS-490 chemistry analyzer; Mindray, Shenzhen, China). The HbA1c levels were measured using turbidimetric immunoassay (Cobas C513; Roche, Basel, Switzerland). GA was measured using an enzymatic test method (AU 5800; Beckman Coulter, Brea, CA, USA) during the third trimester of pregnancy after the diagnosis of GDM.

2) Definitions of maternal and neonatal complications

Cephalopelvic disproportion (CPD) refers to an imbalance between the size of the fetal head and the pelvic inlet during the birthing process. This imbalance results in the inability of the biparietal plane of the head to pass through the pelvic inlet [14]. Preterm birth is defined as the delivery of an infant before the normal gestational age, typically occurring between 20 0/7 weeks and 36 6/7 weeks [15]. Preterm premature rupture of membranes (PPROM) refers to the rupture of membranes that occurs before 37 weeks of pregnancy [16]. PE is defined as having a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg, along with the presence of proteinuria [17].
Macrosomia is defined as a birth weight of 4 kg or more, regardless of gestational age, while overweight infants refer to those whose birth weight exceeds the 90th percentile for their gestational age. Conversely, infants with low birth weight refer to those with a birth weight below the 10th percentile of their gestational age [18]. Transient tachypnea is a condition characterized by temporary respiratory distress with rapid breathing due to abnormal or inadequate ventilation [19]. Neonatal hyperbilirubinemia is classified based on the guidelines for preventing and managing hyperbilirubinemia and may require close monitoring or phototherapy [20].

3. Statistical Analysis

The participants were divided into two groups: one without complications and the other with complications. The general characteristics, anthropometric measurements, and blood test results were compared between the groups. For continuous variables, a one-way analysis of variance was used to compare the means; for categorical variables, the chi-square test was used for intergroup analysis.
Furthermore, to determine the optimal cutoff value of GA based on the presence or absence of complications, ROC curves and Youden’s indices were utilized. The Youden’s index is calculated by subtracting 1 from the sum of sensitivity and specificity, with the optimal cutoff value selected based on the maximum value of this index [21,22].
The participants were further categorized into three groups: those without complications, those with complications observed only in the neonate or mother, and those with complications observed in both the neonate and mother. A correlation analysis was performed to determine the relationship between GA levels and these groups.
A P-value of <0.05 was considered significant, and all statistical analyses were conducted using IBM SPSS ver. 29.0 (IBM Corp., Armonk, NY, USA).

RESULTS

1. Characteristics of the Study Population

The participants were divided into two groups based on the presence or absence of complications in either the mother or neonate, and their baseline characteristics were examined (Table 1). A total of 45 and 28 patients developed maternal and neonatal complications, respectively. The different maternal complications identified were cesarean section due to CPD in 39, preterm labor in three, PPROM in one, and PE in one. Meanwhile, the different neonatal complications were macrosomia or overweight in eight patients, admission to the neonatal intensive care unit in 15 patients (including one who developed seizures, seven with transient tachypnea/apnea, five with neonatal hyperbilirubinemia, one with abdominal distention, and one with cleft palate), and low birth weight in five.
The mean age of mothers with complications was 33.52±3.62 years, which was slightly higher than that of mothers without complications (32.87±3.61 years); however, this difference was not significant (P=0.327). Among mothers without complications, 54 (90%) had natural conception, while 6 (10%) had conception through assisted reproductive technology (ART). Among mothers with complications, 45 (75%) had conceived naturally, while 15 (25%) conceived through ART. However, no significant difference was observed between the two groups (P=0.088).
With regard to the mode of delivery, vaginal delivery occurred in 34 mothers (56.7%) without complications and in only 12 mothers (20.7%) with complications. Cesarean delivery was observed in 26 patients (43.3%) without complications, none of which were due to CPD. In the group with complications, 46 infants (79.3%) were delivered via cesarean section, with 39 (67.2%) of these cases attributed to CPD. The differences in delivery methods between the two groups were significant (P<0.001).
At the time of GDM diagnosis, no significant differences were observed in the mean OGTT and HbA1c levels between the two groups. However, in the third trimester, the results of the GA showed a significant difference between the group without complications (11.67%±0.77%) and the group with complications (12.87%±1.11%) (P<0.001).

2. Cut-off Value of Glycated Albumin for Predicting Maternal or Neonatal Complications

The ROC curve showed an AUC of 0.821 (0.745–0.897), and the GA cut-off value with the highest Youden’s index was 12.45% (Figure 2). Based on this cutoff value, the sensitivity for predicting the presence of complications in either the neonate or the mother was 66.7%, while the specificity was 86.7% (Youden’s index: 0.534) (Table 2).

3. Simple Correlation Analysis between Maternal or Neonatal Complications and Glycated Albumin

The participants were classified into three groups: complication 0 (no complications in both the mother and neonate), complication 1 (complications present in either the mother or neonate), and complication 2 (complications present in both the mother and neonate). A correlation analysis was conducted between GA levels and the occurrence of complications in both mothers and neonates. The results revealed a significant linear correlation between maternal and neonatal complications and GA (P<0.001), indicating a moderately positive linear correlation (r=0.621) (Figure 3).

DISCUSSION

This study found that a GA result of 12.45% or higher in the third trimester among Korean women diagnosed with GDM, specifically in those with singleton pregnancies, demonstrated a significant predictive value for maternal or neonatal complications, with a sensitivity of 66.7% and a specificity of 86.7%. These findings are noteworthy because of their significance.
In this study, a significant difference was observed in the GA levels between the group without complications and the group with complications (11.67% versus 12.87%, P<0.001). In another Japanese study comparing the GA levels in the third trimester for predicting neonatal complications in mothers diagnosed with GDM, the group with neonatal hypoglycemia, respiratory disorders, cardiomegaly, and overweight infants had higher GA levels than those without these complications [23]. In another study conducted in China, the average GA level in pregnant women with GDM who had maternal or neonatal complications was 21.0%, which was higher than that in the group without complications (12.0%) [24]. This finding is consistent with the results of the present study that showed higher GA levels in the group with complications. However, a notable difference from previous studies is that the GA levels in the complication group were lower than those reported in the previous study. This finding suggests the differences between East Asian countries.
Additionally, the present study proposed an optimal GA cutoff value of 12.45% for predicting maternal or neonatal complications, which slightly differs from that reported in other studies. In another Chinese study, the upper limit of normal GA for mothers with GDM was set at 15.69%, with levels above this threshold associated with a significant increase in the cesarean section rates and incidence of macrosomia in newborns [24]. This difference in results may be attributed to the variations in average GA levels in the group with complications. Similarly, another study found that a GA level of more than 12.00% in the third trimester was associated with an increased risk of macrosomia [25]. Although this result aligns with our findings, it focused exclusively on complications related to macrosomia. However, our study included various neonatal and maternal complications beyond macrosomia, adding significance to the interpretation of the findings of previous studies. Considering the scarcity of research conducted among Korean populations, these findings are considered both important and valuable.
The results of this study indicated that the correlation between the incidence of maternal and neonatal complications and GA levels was stronger when the complications occurred simultaneously. This observation suggests that elevated GA levels may indicate poor blood sugar control and potentially lead to multiple complications. Only limited studies have examined the simultaneous occurrence of maternal and neonatal complications. The regression analysis of a previous study revealed that the incidence of macrosomia in newborns increased by 1.58 times as GA levels increased. Another study found a positive correlation between the number of neonatal complications and GA levels, indicating that higher GA levels were associated with a greater number of complications [26,27]. These findings suggest that higher GA levels are associated with an increased risk of developing complications. Based on the results of this study, caution should be exercised when considering that the risk of multiple complications in both mothers and neonates increases with higher GA levels.
Currently, no optimal GA values have been established for pregnant women with GDM. However, other studies in healthy pregnant women have proposed certain values. In Europe, the recommended GA ranges during pregnancy are 11.1%–14.8%, 10.9%–15.6%, and 10.6%–14.1% in the first, second, and third trimesters, respectively. In China, the suggested optimal ranges of GA during pregnancy are 11.26%–15.10%, 10.04%–13.50%, and 9.76%–13.09% in the first, second, and third trimesters, respectively [28,29]. These results vary from the general normal range of GA (11.0%–16.0%) and emphasize the need for further research to determine the GA levels during pregnancy [30].
Although this study provides valuable insights as it focused on pregnant Korean women, several limitations should be considered before generalizing the results. First, it was conducted at a single medical institution, which may limit its generalizability to the general population. Second, although the study proposed an optimal cutoff value, the sensitivity associated with this value was low. Third, although the sample size was larger than the number of studies used in the analysis, it remains relatively small compared to the number of features analyzed. Considering these points, further research using big data could address these limitations. Despite these limitations, the significance of this study lies in its focus on Korean patients. The management of Korean pregnant women diagnosed with GDM may require the use of standards that differ from those found in studies conducted in other East Asian countries.
In conclusion, proper glycemic management is important for preventing maternal and neonatal complications in pregnant women diagnosed with GDM. The results of the third trimester GA test may help predict the occurrence of complications in both mothers and newborns. However, since the standard cutoff value of GA may differ by country, more studies are needed to establish standards tailored to the characteristics of Korean individuals.

Notes

CONFLICT OF INTEREST

Jong Sung Kim serves as an Editorial Board member of the Korean Journal Family Medicine but has no role in the decision to publish this article. Except for that, no potential conflict of interest relevant to this article was reported.

ACKNOWLEDGMENTS

We would like to thank Jong Pyo Lee, Seong Rae Song, Jong Seob Lee, Seong Kim, Su-Jin Han, Young Ok Shin, Kyungjoo Cho, Heajo Yoon, Sae Mee Park, and Hye Jin Hwang of Trinium Woman’s Hospital for providing assistance with the study.

Figure. 1.
Flowchart of the patient selection process. GDM, gestational diabetes mellitus; T2DM, type 2 diabetes mellitus; HTN, hypertension.
kjfm-24-0048f1.jpg
Figure. 2.
Receiver operating characteristic (ROC) curve of glycated albumin levels for predicting maternal or neonatal complications. AUC, area under the ROC curve; CI, confidence interval.
kjfm-24-0048f2.jpg
Figure. 3.
Simple correlation analysis between glycated albumin (GA) levels and maternal or neonatal complications.
kjfm-24-0048f3.jpg
Table 1.
Patient characteristics
Characteristic Non-complication (N=60) Complications (N=60) P-value
Age (y) 32.87±3.61 33.52±3.62 0.327
Height (cm) 161.83±4.29 161.86±5.57 0.979
Weight (kg)
 Pre-pregnancy 59.57±9.05 60.74±10.00 0.507
 At delivery 68.49±8.93 70.67±10.08 0.214
Pre-pregnancy body mass index (kg/m2) 22.77±3.38 23.18±3.73 0.531
Parity 0.589
 0 41 (68.3) 46 (76.7)
 1 16 (26.7) 12 (20.0)
 ≥2 3 (5.0) 2 (3.3)
Pregnancy type 0.088
 Natural cycles 54 (90.0) 45 (75.0)
 Assisted reproductive technology
  Intrauterine insemination 1 (1.7) 4 (6.7)
  In vitro fertilization 5 (8.3) 11 (18.3)
Duration of pregnancy (gestational weeks) 39.0±0.6 39.0±1.1 0.841
Delivery type* <0.001
 Normal spontaneous vaginal delivery 34 (56.7) 12 (20.7)
 Cesarean section
  CPD or emergency - 39 (67.2)
  Others (scheduled/repeat) 26 (43.3) 7 (12.1)
 Neonatal birthweight* (kg)
  Men (n=65) 3.32±0.32 3.36±0.55 0.711
  Women (n=53) 3.21±0.25 3.31±0.38 0.296
50 g GCT at diagnosis (mg/dL)
 1-hour 169.17±18.42 166.07±22.69 0.417
100 g OGTT at diagnosis (mg/dL)
 Fasting 89.55±11.26 91.92±10.07 0.230
 1-hour 192.10±22.48 190.46±25.38 0.709
 2-hour 181.52±24.97 185.20±25.63 0.428
 3-hour 151.14±27.09 155.20±23.95 0.391
Hemoglobin A1c (%) at diagnosis 5.44±0.37 5.42±0.37 0.724
Glycated albumin (%) 11.67±0.77 12.87±1.11 <0.001
 Timing of measurement (gestational weeks) 32.4±2.2 32.2±2.4 0.375
Glucose monitoring
 Self-monitoring of blood glucose 59 60
 Continuous glucose monitoring 1 -
Complications
 Maternal complications - 45
  CPD cesarean section - 39
  Preterm labor, birth - 4
  Preterm premature rupture of membrane - 1
  Preeclampsia - 1
 Neonatal complications - 28
  LGA/macrosomia - 8
  Admission to NICU - 15
  Small for gestational age - 5
 Complication 0 (none)* 60 -
 Complication 1 (alone)* - 45
  Maternal only - 30
  Neonatal only - 15
 Complication 2 (both)* - 13
Insulin treatment 0.251
 No 51 (85.0) 45 (75.0)
 Yes 9 (15.0) 15 (25.0)

Values are presented as mean±standard deviation or number (%). Statistical significance was determined using the chi-square test or analysis of variance with the Bonferroni post-hoc test, with significance set at P<0.05.

CPD, cephalopelvic disproportion; GCT, glucose challenge test; OGTT, oral glucose tolerance test; LGA, large for gestational age; NICU, neonatal intensive care unit.

* Excluded 2 transferred cases (preeclampsia 1, preterm labor 1).

Included 2 transferred cases (preeclampsia 1, preterm labor 1).

Seizure 1, transient tachypnea of newborn or apnea 7, hyperbilirubinemia 5, abdominal distension 1, cleft palate 1.

Table 2.
Cutoff values for predicting maternal or neonatal complications
Cutoff points of glycated albumin (%) Sensitivity (%) Specificity (%) Youden index
11.25 95.0 25.0 0.200
11.35 95.0 31.7 0.267
11.45 93.3 35.0 0.283
11.55 91.7 40.0 0.317
11.65 85.0 48.3 0.333
11.75 85.0 53.3 0.383
11.85 85.0 60.0 0.450
11.95 81.7 65.0 0.467
12.05 78.3 70.0 0.483
12.15 78.3 71.7 0.500
12.25 73.3 73.3 0.466
12.35 68.3 80.0 0.483
12.45 66.7 86.7 0.534
12.55 61.7 90.0 0.517
12.65 56.7 90.0 0.467
12.75 50.0 90.0 0.400
12.85 48.3 96.7 0.450

REFERENCES

1. Wicklow B, Retnakaran R. Gestational diabetes mellitus and its implications across the life span. Diabetes Metab J 2023;47:333-44.
crossref pmid pmc pdf
2. Saeedi M, Cao Y, Fadl H, Gustafson H, Simmons D. Increasing prevalence of gestational diabetes mellitus when implementing the IADPSG criteria: a systematic review and meta-analysis. Diabetes Res Clin Pract 2021;172:108642.
crossref pmid
3. Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of gestational diabetes mellitus in Eastern and Southeastern Asia: a systematic review and meta-analysis. J Diabetes Res 2018;2018:6536974.
crossref pmid pmc pdf
4. Korean Diabetes Association. Diabetes fact sheet 2022 (EN) [Internet]. Seoul: Korean Diabetes Association; 2022 [cited 2023 Jan 2]. Available from: https://www.diabetes.or.kr/bbs/?code=fact_sheet&mode=view&number=2500&page=1&code=fact_sheet

5. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol 1991;165(6 Pt 1):1667-72.
crossref pmid
6. Tan PC, Ling LP, Omar SZ. The 50-g glucose challenge test and pregnancy outcome in a multiethnic Asian population at high risk for gestational diabetes. Int J Gynaecol Obstet 2009;105:50-5.
crossref pmid pdf
7. Peters RK, Kjos SL, Xiang A, Buchanan TA. Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus. Lancet 1996;347:227-30.
crossref pmid
8. Schwartz R, Gruppuso PA, Petzold K, Brambilla D, Hiilesmaa V, Teramo KA. Hyperinsulinemia and macrosomia in the fetus of the diabetic mother. Diabetes Care 1994;17:640-8.
crossref pmid pdf
9. Metzger BE, Persson B, Lowe LP, Dyer AR, Cruickshank JK, Deerochanawong C, et al. Hyperglycemia and adverse pregnancy outcome study: neonatal glycemia. Pediatrics 2010;126:e1545-52.
crossref pmid pdf
10. Japan Diabetes Society. Treatment guide for diabetes 2016-2017 [Internet]. Tokyo: Japan Diabetes Society; 2017 [cited 2024 Apr 15]. Available from: https://fa.kyorin.co.jp/jds/uploads/Treatment_Guide_for_ Diabetes_2016-2017.pdf

11. Negida A, Fahim NK, Negida Y. Sample size calculation guide - Part 4: how to calculate the sample size for a diagnostic test accuracy study based on sensitivity, specificity, and the area under the ROC curve. Adv J Emerg Med 2019;3:e33.
pmid pmc
12. Hur KY, Moon MK, Park JS, Kim SK, Lee SH, Yun JS, et al. 2021 Clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. Diabetes Metab J 2021;45:461-81.
pmid pmc
13. Moon JH, Jang HC. Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications. Diabetes Metab J 2022;46:3-14.
crossref pmid pmc pdf
14. Maharaj D. Assessing cephalopelvic disproportion: back to the basics. Obstet Gynecol Surv 2010;65:387-95.
crossref pmid
15. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin no. 171: management of preterm labor. Obstet Gynecol 2016;128:e155-64.
crossref pmid
16. Phillips C, Velji Z, Hanly C, Metcalfe A. Risk of recurrent spontaneous preterm birth: a systematic review and meta-analysis. BMJ Open 2017;7:e015402.
crossref pmid pmc
17. Kim MH, Kwak SH, Kim SH, Hong JS, Chung HR, Choi SH, et al. Pregnancy outcomes of women additionally diagnosed as gestational diabetes by the International Association of the Diabetes and Pregnancy Study Groups criteria. Diabetes Metab J 2019;43:766-75.
crossref pmid pmc pdf
18. Kim HS, Jang HJ, Park JE, Kim MY, Ko SY, Kim SH. Maternal and neonatal outcomes in Korean women with type 1 and type 2 diabetes. Diabetes Metab J 2015;39:316-20.
crossref pmid pmc
19. Moresco L, Calevo MG, Baldi F, Cohen A, Bruschettini M. Epinephrine for transient tachypnea of the newborn. Cochrane Database Syst Rev 2016;2016:CD011877.
crossref pmid pmc
20. Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2022;150:e2022058859.
pmid
21. Fluss R, Faraggi D, Reiser B. Estimation of the Youden index and its associated cutoff point. Biom J 2005;47:458-72.
crossref pmid
22. Bohning D, Bohning W, Holling H. Revisiting Youden’s index as a useful measure of the misclassification error in meta-analysis of diagnostic studies. Stat Methods Med Res 2008;17:543-54.
crossref pmid pdf
23. Sugawara D, Sato H, Makita E, Kuwata T, Takagi K, Ichihashi K. Clinical usefulness of glycated albumin and glycated albumin-to-glycated hemoglobin ratio of gestational diabetes mellitus in late pregnancy for predicting infant complications. Pediatr Neonatol 2022;63:239-46.
crossref pmid
24. Zhang X, Wei Y, Fan L, Zhao Y, Li Y, Liu Y, et al. A multicenter all-inclusive prospective study on the relationship between glycemic control markers and maternal and neonatal outcomes in pregnant women. J Matern Fetal Neonatal Med 2021;34:3154-61.
crossref pmid
25. Li HP, Wang FH, Tao MF, Huang YJ, Jia WP. Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus. J Diabetes Investig 2016;7:48-55.
pmid
26. Mendes N, Alves M, Andrade R, Ribeiro RT, Papoila AL, Serrano F. Association between glycated haemoglobin, glycated albumin and fructosamine with neonatal birthweight and large-for-date status infants in gestational diabetes mellitus: a prospective cohort study. J Obstet Gynaecol 2019;39:768-73.
crossref pmid
27. Sugawara D, Sato H, Ichihashi K, Nagai K, Kawano A. Glycated albumin level during late pregnancy as a predictive factor for neonatal outcomes of women with diabetes. J Matern Fetal Neonatal Med 2018;31:2007-12.
crossref pmid
28. Paleari R, Vidali M, Ceriotti F, Pintaudi B, Luisa De Angelis M, Vitacolonna E, et al. Reference intervals for glycated albumin during physiological pregnancy of Europid women: evidences from a prospective observational study. Clin Chim Acta 2023;541:117246.
crossref pmid
29. Dong Y, Zhai Y, Wang J, Chen Y, Xie X, Zhang C, et al. Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes. BMC Pregnancy Childbirth 2020;20:12.
crossref pmid pmc pdf
30. Yoo J, Choi Y, Park SA, Seo JY, Ahn CW, Han J. Glycated albumin and glycated albumin/HbA1c predict the progression of coronavirus disease 2019 from mild to severe disease in Korean patients with type 2 diabetes. J Clin Med 2022;11:2327.
crossref pmid pmc
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