Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah, USA.
Department of Obstetrics and Gynecology, Intermountain Health Care, Murray, Utah, USA.
BJOG. 2022 Mar;129(4):619-626. doi: 10.1111/1471-0528.16922. Epub 2021 Oct 14.
To evaluate the association between maternal fructosamine levels at the time of delivery and stillbirth.
Secondary analysis of a case-control study.
Multicentre study of five geographic catchment areas in the USA.
All singleton stillbirths with known diabetes status and fructosamine measurement, and representative live birth controls.
Fructosamine levels in stillbirths and live births among groups were adjusted for potential confounding factors, including diabetes. Optimal thresholds of fructosamine to discriminate stillbirth and live birth.
A total of 529 women with a stillbirth and 1499 women with a live birth were included in the analysis. Mean fructosamine levels were significantly higher in women with a stillbirth than in women with a live birth after adjustment (177 ± 3.05 versus 165 ± 2.89 μmol/L, P < 0.001). The difference in fructosamine levels between stillbirths and live births was greater among women with diabetes (194 ± 8.54 versus 162 ± 3.21 μmol/L), compared with women without diabetes (171 ± 2.50 versus 162 ± 2.56 μmol/L). The area under the curve (AUC) for fructosamine level and stillbirth was 0.634 (0.605-0.663) overall, 0.713 (0.624-0.802) with diabetes and 0.625 (0.595-0.656) with no diabetes.
Maternal fructosamine levels at the time of delivery were higher in women with stillbirth compared with women with live birth. Differences were substantial in women with diabetes, suggesting a potential benefit of glycaemic control in women with diabetes during pregnancy. The small differences noted in women without diabetes are not likely to justify routine screening in all cases of stillbirth.
Maternal serum fructosamine levels are higher in women with stillbirth than in women with live birth, especially in women with diabetes.
评估分娩时母体果糖胺水平与死胎之间的关系。
病例对照研究的二次分析。
美国五个地理区域的多中心研究。
所有已知糖尿病状态和果糖胺测量值的单胎死胎，以及具有代表性的活产对照。
对潜在混杂因素（包括糖尿病）进行调整后，比较死胎组和活产组的果糖胺水平。确定区分死胎和活产的果糖胺最佳阈值。
共纳入 529 名死胎妇女和 1499 名活产妇女进行分析。调整后，死胎妇女的平均果糖胺水平明显高于活产妇女（177±3.05μmol/L 比 165±2.89μmol/L，P<0.001）。糖尿病妇女（194±8.54μmol/L）与非糖尿病妇女（171±2.50μmol/L）相比，死胎与活产妇女之间的果糖胺水平差异更大。果糖胺水平与死胎的曲线下面积（AUC）总体为 0.634（0.605-0.663），有糖尿病时为 0.713（0.624-0.802），无糖尿病时为 0.625（0.595-0.656）。
与活产妇女相比，分娩时母体果糖胺水平在死胎妇女中更高。在患有糖尿病的妇女中差异更大，这表明在妊娠期间对糖尿病妇女进行血糖控制可能会带来潜在益处。在无糖尿病的妇女中，注意到的微小差异不太可能证明在所有死胎病例中都需要常规筛查。
与活产儿相比，死胎母亲的血清果糖胺水平更高，尤其是患有糖尿病的母亲。
