Biomarkers for Assessing Glycemic Control in Pregnancy

Hyperglycemia accounts for one of the most common medical conditions women encounter during pregnancy. Stringent glycemic control is essential during pregnancy as present and future of two generations are at risk- the mother; and the fetus and even mild abnormality of glucose metabolism can increase the incidence of complications. Strict glycemic control cannot be attained without a reliable glycemic control marker, which is lacking till now for pregnancy. Although the determination of blood glucose is the sine qua non for both detection and treatment of hyperglycemic disorders of pregnancy, it is subject to several limitations, many of which are not widely appreciated. Acceptance of supremacy of HbA1c as glycemic control metric outside pregnancy has attracted attention for its use in pregnancy also but owing to the limitations of the HbA1c assay in pregnancy, the interest is growing towards alternative glycemic biomarkers including fructosamine, GA and 1,5-AG. Studies have postulated them as useful tools for monitoring of intermediate and short-term glycemic control in pregnancy and some have even proposed GA as superior and more reliable indicator of glycemic control on pregnancy. However, because little data from clinical studies is available, large-scale epidemiological studies among populations of different races and ethnicity are required in order to confirm any proposals.