Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

Guarnotta, Valentina; Mineo, Mariagrazia Irene; Giacchetto, Emanuela; Imbergamo, Maria Pia; Giordano, Carla

doi:10.1186/s12884-021-03702-y

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…By contrast, women with type 2 diabetes tend to be older, have higher rates of obesity, greater ethnic diversity, and greater socioeconomic deprivation [ 21 , 27 , 28 , 29 ]. Interestingly, it has been observed that there is a poor correlation between HbA1c and perinatal complications in women with type 2 diabetes, thus suggesting that other factors, such as obesity and insulin resistance, may influence the gestational outcomes more than the glycemic control [ 19 , 30 ]. The low number of women with type 2 diabetes in our population does not allow us to address this interesting issue.…”

Section: Discussionmentioning

confidence: 99%

Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes?

et al. 2021

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Background and Objectives: This observational study aims to determine the correlation between glycemic control with the HbA1c value and adverse obstetric outcome in women affected by pre-gestational diabetes. Materials and Methods: A retrospective analysis has been performed at the University Hospital of Udine. Only patients with a singleton pregnancy, pre-gestational diabetes, and known level of Hb A1c throughout pregnancy were included in the study. Results: According to the HbA1c level, at the beginning of pregnancy, 49 patients with HbA1c ≤ 7.0% were compared with 45 patients with HbA1c > 7.0%. Maternal age at diagnosis of the disease was significantly higher in the group with HbA1c ≤ 7% than in the group with HbA1c > 7%, 26.00 (18.00–32.00) vs. 20.00 (12.50–27.00). Women with HbA1c ≤ 7.0% reached, at term of pregnancy, significantly lower levels of HbA1c, 5.8% (5.7–6.0) vs. 6.7% (6.3–7.3). Daily insulin units were statistically different between the two groups at the end of pregnancy (47.92 (39.00–67.30) vs. 64.00 (48.00–82.00)). Proteinuria was significantly higher in the group with HbA1c > 7.0%, who delivered at earlier gestational age (37.57 (35.57–38.00) vs. 38.14 (38.00–38.43). Moreover, women with HbA1c > 7.0% had a significantly higher prevalence of an adverse composite outcome. Of note, in multivariate logistic regression analysis, pregnancy complications were significantly correlated to pre-pregnancy HbA1c > 7.0% (OR 2.95 CI.95 1.16–7.48, p < 0.05) independently of age, insulin treatment, and type of diabetes. Conclusions: Our data, obtained from a single-center cohort study, suggest that starting pregnancy with poor glycemic control might predict more complex management of diabetes in the following trimesters.

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Section: Discussionmentioning

confidence: 99%

Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes?

et al. 2021

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“…No differences were observed in relation to the type and route of gestational termination, number of miscarriage and stillbirth. In contrast to Guarnotta et al who found that women with type 2 DM showed higher prevalence of abortion than Type 1 DM [ 9 ]. A review of the data shows a higher percentage of stillbirth in Type 2 DM, all of them premature, but this does not appear to be significant, possibly due to the small sample size.…”

Section: Discussionmentioning

confidence: 72%

“…In relation to weight gain during pregnancy, Type 2 DM women have lower weight gain during pregnancy, but still have a higher weight at the end of gestation, therefore, Type 2 DM women have worsening obesity and hypertension throughout gestation [ 9 ], and the creation of specially designed treatment measures would be necessary to improve these outcomes.…”

Section: Introductionmentioning

confidence: 99%

Prematurity and congenital malformations differ according to the type of pregestational diabetes

Ballesteros,

Guarque,

Ingles

et al. 2024

BMC Pregnancy Childbirth

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Background Diabetes mellitus (DM) is the most common metabolic disorder in pregnancy. Women with Type 2 DM seems to have no better perinatal outcomes than those with Type 1 DM. Methods Single-center prospective cohort observational study. Pregnant women with diabetes (141 with Type 1 DM and 124 with Type 2 DM) that were followed in the university hospital between 2009 and 2021 were included in this study. Clinical data and obstetric and perinatal outcomes were collected. Results As expected, women with Type 1 DM were younger and had a longer duration of diabetes than women with Type 2 DM. Obesity and chronic hypertension were higher in the group of women with Type 2 DM and their value of HbA1c in the second and third trimesters were lower than in Type 1 DM. No differences in prematurity were found, but more extreme prematurity was observed in Type 2 DM, as well as a higher rate of congenital malformations. The frequency of hypoglycemia and the weight of the newborn was higher in Type 1 DM. The maternal independent factors related to the weight of the newborn were: the glycemic control at the third trimester, the weight gain during pregnancy, and pregestational BMI. Conclusions Newborns born to mothers with Type 1 DM were larger and had a higher frequency of hypoglycemia, while congenital malformations and precocious preterm was more associated to Type 2 DM. Metabolic control, weight gain and pregestational weight were important determinants of both obstetric and neonatal complications.

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“…Patients were instructed to follow a specific nutrition plan based on their pregestational BMI and weight. In addition, they were trained in self-monitoring of blood glucose (SMBG) using a glucose meter, with the instruction to perform a minimum of 4 daily measurements (before and 1 hour after meals), as previously reported [ 20 ]. The American Diabetes Association and the American College of Obstetricians and Gynecologist (ACOG) recommend similar glucose targets for women with pre-existing diabetes and GDM as follows: fasting glucose less than or equal to 95 mg/dL (5.28 mmol/L), 1 hour after eating less than or equal to 140 mg/dL (7.78 mmol/L) and 2 hours after eating less than or equal to 120 mg/dL (6.67 mmol/L) [ 11 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

Myoinositol supplementation in the treatment of gestational diabetes mellitus: effects on glycaemic control and maternal-foetal outcomes

Guarnotta

Cuva

Imbergamo

et al. 2022

BMC Pregnancy Childbirth

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Background Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy. It is characterized by high risk of adverse outcomes for the mother and the foetus, if not adequately controlled. The aim of the study was to evaluate the effects of 4000 mg of myoinositol supplementation in women with GDM on maternal-foetal outcomes, compared to controls. Methods A cohort of 330 women with GDM, 150 supplemented with myoinositol and 180 controls were enrolled. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed. Results The same number of women in the two groups started insulin as additional therapy. Women treated with myoinositol more frequently had a long-acting insulin scheme of treatment than those untreated (p<0.001), while women untreated with myoinositol more frequently had a basal-bolus insulin regimen (p<0.001) compared to women on myoinositol. Patients treated with myoinositol had significantly lower fasting plasma glucose (p=0.032), post-prandial dinner glucose (p=0.014), insulin requirement both in the 2nd and in the 3rd trimesters (p=0.001 and p<0.001, respectively), than those not treated with myoinositol. With regard to maternal/foetal outcomes, lower birth weight (p=0.043) and frequency of hypoglycaemic events (p=0.001) were observed in women treated with myoinositol compared to controls. Conclusions Women with GDM treated with myoinositol showed an improved glycaemic control in the 3rd trimester of pregnancy and a lower insulin requirement, when insulin was added to the treatment, compared to controls. In addition, they showed lower preterm birth weight and neonatal hypoglycaemia, compared to women not supplemented with myoinositol.

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Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

Cited by 11 publications

References 26 publications

Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes?

Is Glycated Hemoglobin A1c Level Associated with Adverse Pregnancy Outcomes of Women Affected by Pre-Gestational Diabetes?

Prematurity and congenital malformations differ according to the type of pregestational diabetes

Myoinositol supplementation in the treatment of gestational diabetes mellitus: effects on glycaemic control and maternal-foetal outcomes

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