Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester
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Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester. / Damm, Peter; Mersebach, Henriette; Råstam, Jacob; Kaaja, Risto; Hod, Moshe; McCance, David R; Mathiesen, Elisabeth R.
In: Journal of Maternal - Fetal & Neonatal Medicine, Vol. 27, No. 2, 01.2014, p. 149-154.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester
AU - Damm, Peter
AU - Mersebach, Henriette
AU - Råstam, Jacob
AU - Kaaja, Risto
AU - Hod, Moshe
AU - McCance, David R
AU - Mathiesen, Elisabeth R
PY - 2014/1
Y1 - 2014/1
N2 - OBJECTIVE: To analyse data from a randomised, controlled study of prandial insulin aspart versus human insulin, both with NPH insulin, in pregnant women with type 1 diabetes for potential factors predicting poor pregnancy outcomes. RESEARCH DESIGN/METHOD: Post hoc analysis including 91 subjects randomised prior to pregnancy with known outcome in early pregnancy and 259 subjects randomised prior to pregnancy/during pregnancy of <10 weeks' gestation with known late-pregnancy outcomes. Poor early-pregnancy outcomes included fetal loss <22 gestational weeks and/or congenital malformation (n=18). Poor late-pregnancy outcomes included: composite endpoint including pre-eclampsia, preterm delivery and perinatal death (n=78); preterm delivery (n=63); and excessive fetal growth (n=88).RESULTS: 18 patients experienced a malformed/lost fetus in early pregnancy - none preceded by severe hypoglycaemia. Albuminuria in early pregnancy was a significant predictor of poor late-pregnancy outcome (composite endpoint; p=0.012). In the third trimester, elevated HbA1c, ≥ 1 plasma glucose (PG) measurement >11 mmol/L (198 mg/dL) and %PG values outside 3.9-7.0 mmol/L (70-126 mg/dL) were significant predictors of poor late-pregnancy outcomes (all p<0.05).CONCLUSIONS: Elevated HbA1c, high glucose spikes and out-of-range %PG in the third trimester, and albuminuria in early pregnancy, are associated with poor late-pregnancy outcomes.
AB - OBJECTIVE: To analyse data from a randomised, controlled study of prandial insulin aspart versus human insulin, both with NPH insulin, in pregnant women with type 1 diabetes for potential factors predicting poor pregnancy outcomes. RESEARCH DESIGN/METHOD: Post hoc analysis including 91 subjects randomised prior to pregnancy with known outcome in early pregnancy and 259 subjects randomised prior to pregnancy/during pregnancy of <10 weeks' gestation with known late-pregnancy outcomes. Poor early-pregnancy outcomes included fetal loss <22 gestational weeks and/or congenital malformation (n=18). Poor late-pregnancy outcomes included: composite endpoint including pre-eclampsia, preterm delivery and perinatal death (n=78); preterm delivery (n=63); and excessive fetal growth (n=88).RESULTS: 18 patients experienced a malformed/lost fetus in early pregnancy - none preceded by severe hypoglycaemia. Albuminuria in early pregnancy was a significant predictor of poor late-pregnancy outcome (composite endpoint; p=0.012). In the third trimester, elevated HbA1c, ≥ 1 plasma glucose (PG) measurement >11 mmol/L (198 mg/dL) and %PG values outside 3.9-7.0 mmol/L (70-126 mg/dL) were significant predictors of poor late-pregnancy outcomes (all p<0.05).CONCLUSIONS: Elevated HbA1c, high glucose spikes and out-of-range %PG in the third trimester, and albuminuria in early pregnancy, are associated with poor late-pregnancy outcomes.
KW - Adult
KW - Albuminuria
KW - Blood Glucose
KW - Congenital Abnormalities
KW - Diabetes Mellitus, Type 1
KW - Female
KW - Fetal Death
KW - Food
KW - Gestational Age
KW - Hemoglobin A, Glycosylated
KW - Humans
KW - Insulin
KW - Insulin Aspart
KW - Insulin, Isophane
KW - Pre-Eclampsia
KW - Pregnancy
KW - Pregnancy Outcome
KW - Pregnancy Trimester, Third
KW - Pregnancy in Diabetics
U2 - 10.3109/14767058.2013.806896
DO - 10.3109/14767058.2013.806896
M3 - Journal article
C2 - 23687948
VL - 27
SP - 149
EP - 154
JO - Journal of Maternal-Fetal Medicine
JF - Journal of Maternal-Fetal Medicine
SN - 1476-7058
IS - 2
ER -
ID: 138430996