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Evaluation of the glycemic control in neonates: a novel technical approach for measuring fetal-glycated hemoglobin

Journal of Perinatology volume 31, page 807 (2011)Cite this article

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In a recent article reported by Koga et al.,1 the authors explored the usefulness and potential of measuring glycated hemoglobins (GHbs) and glycated albumin in cord blood, evaluated by various techniques including high-performance liquid chromatography, latex-immunoturbidimetry, enzymatic and affinity methods. They found that by using two high-performance liquid chromatography methods, the latex-immunoturbidimetry method and the enzymatic method, the determination of GHb levels were low when compared with adult normal reference values. They also mentioned that, although these techniques could specifically determine glycated β-chains, they were not capable of determining glycated γ-chains derived from fetal hemoglobin (HbF), and they concluded that serum-glycated albumin, but not GHb, could be used as a glycemic control indicator in neonates.

Clearly, the coexistence of hemoglobin F [HbF(α2γ2)], and hemoglobin A [HbA(α2β2)] in neonatal blood makes the determination of GHb a daunting challenge. There are different possible reasons for this: (1) from a molecular point of view, cord blood hemoglobin is a mixture of α-, β- and γ-subunits and glycation may occur in all of them; (2) adding to the complexity, HbF is itself a mixture of two molecular species (α2Gγ2 and α2Aγ2), differing only at position 136, if either a Gly or an Ala is present; (3) moreover, HbF is acetylated2 significantly (at 11.6±2.8%)3 at the N-terminus of the γ-chain, which needs to be taken into account for acute measurements of GHb; and (4) measurement of GHb in cord blood must be selective in order to determine glycation as ratios relative to the corresponding hemoglobin chain, consequently GHb levels will not be affected by the variation in γ- and β-chains levels (fetal to adult hemoglobin ‘switch’ by the end of pregnancy).

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References

  1. Koga M, Murai J, Saito H, Yamada Y, Mori T, Suno S et al. Measurement of glycated hemoglobin and glycated albumin in umbilical cord: evaluation of the glycemic control indicators in neonates. J Perinatol 2010; 1–4.

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Authors and Affiliations

  1. Department of Physiology and Biophysics, Université de Sherbrooke, CHUS, Hospital Fleurimont, Sherbrooke, Quebec, Canada

    F O Dupont, J Ménard & J L Ardilouze

  2. Department of Pediatrics, Université de Sherbrooke, CHUS, Hospital Fleurimont, Sherbrooke, Quebec, Canada

    R Gagnon & C Auray-Blais

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  1. F O Dupont
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  2. R Gagnon
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  3. J Ménard
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  4. C Auray-Blais
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  5. J L Ardilouze
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Correspondence to C Auray-Blais.

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Dupont, F., Gagnon, R., Ménard, J. et al. Evaluation of the glycemic control in neonates: a novel technical approach for measuring fetal-glycated hemoglobin. J Perinatol 31, 807 (2011). https://doi.org/10.1038/jp.2011.70

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