Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes

Perea, Verónica; Bertran, Berta; Bellart, Jordi; Orois, Aida; Giménez, Marga; Conget, Ignacio; Vinagre, Irene

doi:10.1002/dmrr.3176

Cited by 12 publications

(23 citation statements)

References 41 publications

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“…After adjusting for risk factors such as gestational hypertension, triglyceride, fetal distress in utero and premature delivery, multivariate logistic regression revealed that maternal FBG level in the second trimester of pregnancy was associated with a decreased risk of NA [(AOR 0.26; 95% CI 0.08 to 0.80) per mmol/L increase in FBG level in the second trimester of pregnancy], which was unreported in previous studies. The results from a study evaluating hypoglycemia and adverse pregnancy outcomes in women with type 1 diabetes, impaired awareness of hypoglycemia (IAH) was associated with an increased risk of neonatal respiratory distress (AOR 11.24, 95% CI 1.01-124.9) [27], were similar to our ndings. Additionally, maternal FPG in the third trimester was not signi cantly associated with asphyxia in our study.…”

Section: Discussionsupporting

confidence: 85%

Maternal Low Fasting Plasm Glucose in the Second Trimester is Associated with Neonatal Asphyxia

Yuan

Yang

et al. 2020

Preprint

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Background Neonatal asphyxia (NA) is associated with neonatal respiratory distress syndrome, cerebral palsy and neonatal death. Risk factors for NA have been identified as maternal hypertension, premature birth and anemia. While the effect of maternal fasting plasm glucose (FPG) in the second trimester of pregnancy on NA remains unclear. Method Retrospective data from 9661 singleton newborns and mothers were analyzed from January 2016 to July 2018 in Tongzhou district, Beijing. Multivariate logistic regression was used to investigate the risk factors of NA, adjusted for gestational hypertension, triglyceride in the second trimester of pregnancy, fetal distress in utero and preterm birth. Results Of the 9,661 newborns, 26 (2.7‰) were diagnosed with neonatal death (Apgar score 1min = 0) and 52 (5.4‰) with varying degrees of asphyxia (Apgar score 1min = 1 to 6). The asphyxia group showed lower FPG [asphyxia group vs non-asphyxia group, 4.5±0.4 vs 4.8±0.5 mmol/L, P<.01], higher triglyceride level (asphyxia group vs non-asphyxia group, 3.0±1.3 vs 2.5±1.9 mmol/L P<.01) in the second trimester, higher rates of gestational hypertension, fetal distress in utero, preterm birth than the non-asphyxia group (P<.05). Multivariate logistic regression revealed that lower FPG in the second trimester was an independent risk factor of NA [adjusted odds ratio (AOR) 0.26; 95% CI 0.08 to 0.80]. Conclusion Pregnant women with low fasting glucose in the second trimester of pregnancy are at increased risk of birth asphyxia in their offspring.

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Section: Discussionsupporting

confidence: 85%

Maternal Low Fasting Plasm Glucose in the Second Trimester is Associated with Neonatal Asphyxia

Yuan

Yang

et al. 2020

Preprint

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“…Furthermore, this atherogenic pattern seems to persist 6 years after any kind of gestational hypertensive disorder, including pre‐eclampsia 19 . Among the pregnant T1D population, however, the relationship with lipid parameters has been scarcely studied, with contradictory findings so far 17,31 . Our results suggest that, even almost 10 years after this obstetric disorder, pre‐eclampsia could be associated with some subtle changes in triglyceride‐related variables.…”

Section: Discussionmentioning

confidence: 60%

“…Our results suggest that, even almost 10 years after this obstetric disorder, pre‐eclampsia could be associated with some subtle changes in triglyceride‐related variables. These changes, which are completely overlooked in the conventional analysis, argue in favour of the role of triglycerides in the pathogenesis of pre‐eclampsia, regardless of the glycaemic status of the women 16,31,32 …”

Section: Discussionmentioning

confidence: 99%

Nuclear magnetic resonance lipoproteins are associated with carotid atherosclerosis in type 1 diabetes and pre‐eclampsia

Amor

Vinagre

Valverde

et al. 2020

Diabetes Metabolism Res

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AimsPersistence of lipoprotein abnormalities in type 1 diabetes (T1D) and/or pre‐eclampsia could be associated with cardiovascular disease (CVD). We assessed differences in the advanced lipoprotein profiles according to the presence of both conditions and their differential association with atherosclerosis.Material and methodsWe recruited 112 women without CVD and last pregnancy ≥5 years previously, divided into four groups (n = 28 per group): (a) T1D and previous pre‐eclampsia; (b) T1D without pre‐eclampsia; (c) pre‐eclampsia without T1D; and (d) controls (without T1D/pre‐eclampsia). Groups were matched by several risk factors, and diabetes duration and retinopathy in T1D. Carotid intima‐media thickness (IMT) and the presence of plaque (IMT ≥1.5 mm) were assessed by ultrasonography. The lipoprotein profile was evaluated by nuclear magnetic resonance (NMR) spectroscopy.ResultsThe participants were 44.9 ± 7.8 years old. Carotid plaque presence was 20.5%, with a higher prevalence in T1D and/or pre‐eclampsia vs controls (P < .05). High‐density lipoprotein (HDL)‐related variables differed among groups, mainly driven by an increase in T1D (P < .05), whereas triglyceride‐related variables were increased in pre‐eclampsia [medium very low‐density lipoprotein (VLDL) particles and triglyceride enrichment in HDL and low‐density lipoprotein (LDL)]. Overall, in multivariate‐adjusted models, LDL‐related variables were the most strongly associated with atherosclerosis (P < .05). In age‐ and statin‐adjusted models, previous pre‐eclampsia showed an independent association with triglyceride‐related variables (plaque: medium‐VLDL‐particles, OR 1.550 [1.013‐2.374]; HDL‐cholesterol/HDL‐triglycerides ratio, OR 0.411 [0.175‐0.967]). Regarding T1D, HDL‐parameters were also differentially associated (maximum‐IMT: HDL‐cholesterol/HDL‐particles ratio, β = −.258, P = .036).ConclusionsNMR lipoproteins were differentially and independently associated with atherosclerosis in T1D/pre‐eclampsia. Further studies are needed to ascertain the role of NMR parameters as CVD biomarkers in this high‐risk population.

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“…In addition, increasing BMI values in the pregnant population and the fear of physicians relating to GDM‐related obstetric complications seem to result in the frequent administration of low‐carbohydrate diets during pregnancy 32 . However, pregnant women are prone to hypoglycemia, and so unbalanced diets may easily lead to decreased blood glucose levels which may cause both maternal and fetal complications 33 . Thus, physicians should be particularly cautious about this issue; detailed information related to the possible adverse effects of low maternal glucose levels should be given to pregnant women during the antenatal follow‐up program.…”

Section: Discussionmentioning

confidence: 99%

Use of the 50‐g glucose challenge test to predict small‐for‐gestational‐age neonates

Eyupoglu

Fadıloğlu

Zengin

et al. 2020

Journal of Diabetes

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Background: To determine a cutoff value for the 50-g glucose challenge test (50-g GCT) for the prediction of small-for-gestational-age (SGA) neonates. Methods: This retrospective cohort study was conducted among pregnant women who were screened with the 50-g GCT at Hacettepe University Hospital between 1 January 2016 and 31 March 2019. Patients with 50-g GCT values <74 mg/dL (<10th percentile) served as the study group (n = 244), while patients with 50-g GCT values between 74 to 139 mg/dL served as the control group (n = 3104). Groups were compared in terms of demographic features, clinical characteristics, and obstetric outcomes. Logistic regression analysis was used to determine independent predictors of SGA. Receiver operating characteristic curves were used to assess the performance of 50-g GCT values in predicting SGA. Results: Lower birthweight, birthweight percentile, and 5th-minute Apgar values, together with higher rates of SGA, were observed in the study group (P < .001 for all). A 50-g GCT value below the 10th percentile (odds ratio: 3.29, 95% CI: 2.31-4.69, P < .001) was a significant independent factor for SGA. A cutoff value of 89.5 mg/dL (84.9% sensitivity, 85.6% specificity) was determined for SGA. Conclusions: Low 50-g GCT values (<89.5 mg/dL) may be an early indicator for SGA. K E Y W O R D S 50-g glucose challenge test, cutoff value, gestational diabetes mellitus, pregnancy, screening, small for gestational age Highlights Low 50-g glucose challenge test (50-g GCT) values may be an early indicator for SGA neonates, and physicians should be cautious especially with regard to values less than 89.5 mg/dL.

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Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes

Cited by 12 publications

References 41 publications

Maternal Low Fasting Plasm Glucose in the Second Trimester is Associated with Neonatal Asphyxia

Maternal Low Fasting Plasm Glucose in the Second Trimester is Associated with Neonatal Asphyxia

Nuclear magnetic resonance lipoproteins are associated with carotid atherosclerosis in type 1 diabetes and pre‐eclampsia

Use of the 50‐g glucose challenge test to predict small‐for‐gestational‐age neonates

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