Different intensities of glycaemic control for pregnant women with pre-existing diabetes

Middleton, Philippa; Crowther, Caroline A; Simmonds, Lucy

doi:10.1002/14651858.cd008540.pub4

Cited by 28 publications

(12 citation statements)

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“…It thus seems that strict glycemic control alone is unable to optimally reduce the fetal and maternal complications related to diabetic pregnancies; however, the Cochrane review had some limitations: only 3 small trials were judged suitable for inclusion in the analysis, no trials were available on type 2 pregnant women, only glucose measurements were considered, and there were no details on patients' compliance and formal education or their understanding of how to monitor their own blood glucose levels appropriately. We consequently agree with the authors' conclusions, that 'Future trials comparing interventions, rather than control targets, may be more feasible particularly for pregnant women with type 2 diabetes' [18].…”

Section: Target Of Metabolic Controlsupporting

confidence: 85%

“…Two of them compared very strict fasting glucose limits (3.33-5.0 mmol/l) with less strict glycemic targets (4.45-6.38 mmol/l), and showed very few differences between the two groups, although there were more hypoglycemic episodes in women under the stricter regime. One trial (involving 60 women) compared strict (≤5.6 mmol/l fasting glucose), moderate (5.6-6.7 mmol/l fasting glucose), and permissive glycemic control (6.7-8.9 mmol/l fasting glucose), and found significantly higher rates of preeclampsia, cesarean section, and large babies in the least strictly controlled group [18]. It thus seems that strict glycemic control alone is unable to optimally reduce the fetal and maternal complications related to diabetic pregnancies; however, the Cochrane review had some limitations: only 3 small trials were judged suitable for inclusion in the analysis, no trials were available on type 2 pregnant women, only glucose measurements were considered, and there were no details on patients' compliance and formal education or their understanding of how to monitor their own blood glucose levels appropriately.…”

Section: Target Of Metabolic Controlmentioning

confidence: 99%

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Pregnancy and Diabetes

Lapolla¹,

Dalfrà²

2014

Frontiers in Diabetes

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Achieving good metabolic control during the period prior to conception is the key to reducing congenital malformations that can occur in pregnancies complicated by diabetes. Various different glycated hemoglobin (HbA 1c ) levels (the gold standard for ascertaining metabolic control in diabetes) and glucose levels have been recommended. The current guidelines and latest studies on the best levels to obtain in diabetic women before and during pregnancy are reported here and discussed. Finally, the optimal therapeutic approach and the possible benefits and risks related to the use of the new insulin analogues in pregnancy will be analyzed. © 2015 S. Karger AG, BaselEven today, pregnancy in diabetic women is a high-risk condition for both the mother and fetus [1]. The prevalence of type 2 diabetes is continuously rising worldwide and more women of reproductive age have diabetes. This means there are more pregnancies complicated by type 2 diabetes, a condition that shares the same risks for mother and fetus as type 1 diabetes [2].There is plenty of evidence that neonatal conditions in pregnancy complicated by diabetes, such as congenital malformations, hypoglycemia, hypocalcemia, hyperbilirubinemia, macrosomia, intrauterine growth retardation, respiratory distress syndrome, polycythemia, and hypertrophic myocardiopathy are caused by hyperglycemia [3]. According to the Pedersen hypothesis, maternal hyperglycemia leads to fetal hyperglycemia, which causes fetal hyperinsulinemia, fetal overgrowth, and macrosomia [4]. Fetal hyperinsulinemia also induces increased metabolism and tissue hypoxia, which are responsible for other neonatal complications. These risks can be reduced by optimal glycemic control both prior to conception and during pregnancy. This can be achieved by means of comprehensive preconception care and strict follow-up dur-

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Section: Target Of Metabolic Controlsupporting

confidence: 85%

Section: Target Of Metabolic Controlmentioning

confidence: 99%

Pregnancy and Diabetes

Lapolla¹,

Dalfrà²

2014

Frontiers in Diabetes

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“…In the 80's of the last century, risks of diabetesrelated complications during pregnancy were 50% higher than in healthy pregnant women 2 . Although current insulin therapy has improved the quality of glycemic control, women with diabetes, especially those with type 1 diabetes compared with women without diabetes, have worse pregnancy outcomes, as well as increased incidence of spontaneous abortions, pre-eclampsia, fetal macrosomia, preterm delivery, congenital anomalies and perinatal mortality [5][6][7][8] . Numerous studies have shown that the incidence of adverse pregnancy outcomes in women with type 2 diabetes is the same as in women with type 1 diabetes, and worse than in the population of healthy women 3,6,7 .…”

Section: Introductionmentioning

confidence: 99%

“…Many studies showed that adverse pregnancy outcomes (congenital anomalies, spontaneous abortions and perinatal mortality) were associated with poor glycemic control in the early pregnancy [6][7][8] . The critical period is before 7 weeks of gestation, that is during organogenesis.…”

Section: Introductionmentioning

confidence: 99%

The impact of diabetes mellitus on the course and outcome of pregnancy during a 5-year follow-up

et al. 2014

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The results of our study show a higher incidence of perinatal fetal morbidity (hypoglycemia, jaundice, respiratory distress syndrome) in the patients with type 1, type 2 and gestation diabetes than in the healthy controls. Also, we found a higher incidence of cesarean section in the patients with type 1 diabetes than in those with type 2, gestation diabetes and healthy controls. Although delivery in the patients with type 1, type 2 and gestational diabetes was completed approximately one to two weeks earlier compared to the healthy controls there was no statistically significant difference in the incidence of preterm delivery (≤ 36th week of gestation) between the women with diabetes and healthy controls. Preterm delivery associated with poorer glycaemic control reflected through higher values of HbA1c in third trimester. Risks from adverse pregnancy outcomes may be reduced to minimum by adequate preconception counseling of diabetic patients and early diagnosis of diabetes in pregnancy, in order to achieve glycemic control during organogenesis and within pregnancy and through the teamwork of endocrinologists, gynecologists and pediatricians.

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“…Others report that when evaluating type 2 diabetes, those with preconception care had lower rates of fetal malformations than those without preconception care[ 18 ]. A large meta-analysis supports the claim that there is evidence of increased pre-eclampsia, cesarean delivery, and macrosomia for women with type 1 diabetes that have poor glycemic control[ 19 ]. Conversely, strong glucose control among type 1 diabetes has been associated with decreased risk for perinatal mortality, decreased maternal hypoglycemia, and normal fetal weight[ 20 - 22 ].…”

Section: Introductionmentioning

confidence: 92%

Association of types of diabetes and insulin dependency on birth outcomes

Xaverius¹,

Howard²,

Kiel³

et al. 2022

WJCC

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BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes. AIM To investigate differences in birth outcomes (preterm birth, macrosomia, and neonatal death) by diabetes status. METHODS Cross-sectional design, using linked Missouri birth and death certificates (singleton births only), 2010 to 2012 ( n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and infant mortality. Confounders included demographic characteristics, adequacy of prenatal care, body mass index, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status. RESULTS Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87, aOR 1.77, and aOR 1.73, respectively) and having a very large baby [macrosomia] (aOR 3.01, aOR 2.12, and aOR 1.96, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women. CONCLUSION Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

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Different intensities of glycaemic control for pregnant women with pre-existing diabetes

Abstract: intensities of glycaemic control for pregnant women with pre-existing diabetes.

Cited by 28 publications

References 50 publications

Pregnancy and Diabetes

Pregnancy and Diabetes

The impact of diabetes mellitus on the course and outcome of pregnancy during a 5-year follow-up

Association of types of diabetes and insulin dependency on birth outcomes

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