Maternal serum fructosamine levels and stillbirth: A case-control study of The Stillbirth Collaborative Research Network.

OBJECTIVE To evaluate the association between maternal fructosamine levels at the time of delivery and stillbirth. DESIGN Secondary analysis of a case-control study. SETTINGS Multicenter study of five geographic catchment areas in the United States (U.S). POPULATION OR SAMPLE All singleton stillbirths with known diabetes status and fructosamine measurement and representative live birth controls. MAIN OUTCOME MEASURES Fructosamine levels in stillbirths and live births among groups were adjusted for potential confounders including diabetes. Optimal thresholds of fructosamine to discriminate stillbirth and live birth. RESULTS 529 women with a stillbirth and 1499 with a live birth were included the analysis. Mean fructosamine levels were significantly higher in women with a stillbirth than a live birth after adjustment (177 ± 3.05 vs. 165 ± 2.89 μmol/L, p<0.001). The difference in fructosamine levels between stillbirths and live births was greater among diabetic women (194 ± 8.54 vs. 162 ± 3.21 μmol/L) compared to those without diabetes (171 ± 2.50 vs. 162 ± 2.56 μmol/L). The 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. CONCLUSION Maternal fructosamine levels at the time of delivery were higher in women with stillbirth compared to live birth. Differences were substantial in women with diabetes, suggesting a potential benefit of glycemic control in women with diabetes during pregnancy. The small differences noted in women without diabetes likely do not justify routine screening in all cases of stillbirth.