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.

This study aims to investigate associations between glycated haemoglobin (HbA1c), glycated albumin (GA) and fructosamine with neonatal birthweight in gestational diabetes mellitus (GDM). The prospective cohort consisted of 82 women with GDM and their newborns, enrolled between November 2016 and September 2017. Considering neonatal birthweight and birthweights ≥90th percentile for gestational age as outcomes, linear and logistic regression models were used, respectively. Fructosamine (R2=0.62) and GA (R2=0.61) performed very similarly between them and best than HbA1c (R2=0.58). The added value of GA or fructosamine to HbA1c resulted in increase in models' performances. GA attained the best discriminative ability regarding large-for-date status babies (AUC = 0.80, OR-estimate 1.58, p=.001) followed by fructosamine (AUC = 0.78, OR-estimate 1.42, p=.001) and HbA1c (AUC = 0.69, OR-estimate 3.09, p=.070). GA and fructosamine, besides from providing additional information to HbA1c, when used separately perform better than the traditional biomarker in predicting neonatal birthweight and large-for-date babies in pregnant women with GDM. Impact statement What is already known on this subject? HbA1c is the standard glycaemic indicator used in GDM. Its association with birthweight and large-for-date status has been previously reported. However, it has become increasingly questionable whether it is a suitable glycaemic marker in pregnancy. There is a growing interest in other non-traditional shorter-term glycaemic indicators, such as GA and fructosamine. Nevertheless, few studies exist and almost all are retrospective and with ethnically homogeneous study populations composed by pregnant women not only with GDM but also type 1 and type 2 diabetes mellitus. What do the results of this study add? Our prospective multi-ethnic cohort composed solely on pregnant women with GDM and their infants show that even though all of the aforementioned biomarkers are associated with birthweight and large-for-date status in GDM when used separately, GA and fructosamine seem to perform better than HbA1c. When used with HbA1c, they improve the predicting performance of the traditional marker. What are the implications of these findings for future clinical practice and/or further research? These findings suggest that GA and fructosamine can provide important additional or substitute information to HbA1c in GDM, namely in predicting birthweight and large-for-date status babies. Larger studies are needed to confirm if this non-traditional biomarkers can change clinical practice.

Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus.

Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.

Sexual and reproductive health of Portuguese adolescents.

BACKGROUND: As adolescent pregnancy and sexually transmitted infections (STIs) are major sources of morbidity, preventing them is an important health goal for Portuguese society. OBJECTIVE: To review data on the knowledge, attitudes and statistics on sexual and reproductive health. METHODS: A systematic review was conducted including peer-reviewed articles addressing issues influencing the sexuality of Portuguese adolescents (aged 13 to 19), published up to 2011 and conducted in any type of setting. After crossing-cleaning the reference list, 33 articles were included. RESULTS: The rate of sexual activity by Portuguese adolescents is high (44%-95%), but there has been an increase in the age of intercourse debut (currently 15.6 years). Early commencement of sexual intercourse is associated with smoking and regular alcohol consumption. Condoms are the most frequently chosen contraceptive method for first (76%-96%) and subsequent (52%-69%) sexual encounters. The perception of a double standard in sex still exists in teenage culture for both genders and influence behavior. There are significant differences between migrant and native adolescents: African adolescents initiate sexual intercourse at earlier ages and are more likely to have unprotected sex. Only one-third of Portuguese teenagers have ever visited a health facility to seek counseling concerning contraception or STIs, and less than half have ever attended classes on reproductive health. Very few (12%) have knowledge about Chlamydia trachomatis infection. The prevalence of STIs in Portuguese youth is unknown. The adolescent fertility rate is still high (14.7 births per 1000 females aged 15-19 years), but it, as well as the rate of abortion, is steadily decreasing. CONCLUSIONS: There is still a long way to go towards promoting a resourceful young population. Citizens and institutions must focus on increasing both the competence of youths and external supports. Information must be provided systematically and health services must have greater accessibility. Studies addressing cultural and environmental determinants that contribute to the molding of the sexual conduct of Portuguese adolescents must be held to produce new and effective culturally sensitive health interventions.

Association between glycated albumin, fructosamine, and HbA1c with neonatal outcomes in a prospective cohort of women with gestational diabetes mellitus.

OBJECTIVE: To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). METHODS: Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. RESULTS: A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. CONCLUSION: Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.

In situ breakage of Implanon®--two cases of a rare occurrence.

BACKGROUND: In situ breakage of Implanon® is a rare occurrence with unknown clinical significance. Authors report two different cases of broken Implanon® of women attended at our Family Planning Clinic. DISCUSSION: In situ implants may spontaneously and asymptomatically break, although some uncertainty relies on whether that situation has a real impact on the contraceptive effectiveness or on bleeding patterns. Even more, it can be argued if, as a result of an occurrence of that nature, the implant shall or shall not be removed before the envisaged 3-year period of effectiveness. CONCLUSION: Currently, the clinical significance of implant breakage remains unknown. The decision to remove a broken or bent implant should be based on clinical judgements considering patients' wishes.