Fructosamine and HbA1c for Monitoring Diabetes in Pregnancy: <i>Complementary or competing?</i>

Objectives: This study aimed to perform a comparative evaluation of glycaemic control using fructosamine and glycated haemoglobin (HbA1c) and to investigate the correlations between the means of these biomarkers and mean glycaemia in pregnant women. Methods: This prospective longitudinal study was conducted from January to December 2020 and included pregnant women with pregestational diabetes, recruited at the National Institute of Nutrition of Tunis, Tunis, Tunisia, before 12 weeks of amenorrhoea and followed-up until delivery. Results: A total of 71 pregnant women were included in this study. Glycaemic values decreased over the course of pregnancy and patients achieved better adherence to target glucose ranges. This improvement was statistically significant for fructosamine (P = 0.03) but not for HbA1c. Significant correlations were identified among mean HbA1c (P <0.001), fructosamine (P <0.001) and corrected fructosamine levels (P <0.001). Trimester-specific analyses indicated that mean HbA1c was significantly correlated with fasting and mean blood glucose levels exclusively in the first trimester. Fructosamine levels exhibited significant positive correlations with fasting and mean blood glucose levels during the first trimester (r = 0.468 and r = 0.523, respectively; P <0.001) as well as with mean blood glucose levels in the second (r = 0.494; P <0.001) and third trimesters (r = 0.348; P = 0.03). Corrected fructosamine levels were significantly positively correlated with mean fasting and mean blood glucose levels in the first (P <0.001) and second trimesters (P <0.001) and with mean blood glucose levels in the third trimester (P = 0.01). Conclusion: These findings indicate that fructosamine and HbA1c serve complementary roles in monitoring glycaemic control during pregnancy among women with diabetes.