Novel Biochemical Markers of Glycemia to Predict Pregnancy Outcomes in Women With Type 1 Diabetes

Meek, Claire L; Tundidor, Diana; Feig, Denice S.; Yamamoto, Jennifer M.; Scott, Eleanor M.; Diane, D; Halperin, José A.; Murphy, Helen; Corcoy, Rosa

doi:10.2337/dc20-2360

Cited by 44 publications

(40 citation statements)

References 40 publications

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“…58–60 Our own work in women with type 1 diabetes confirmed the association between 1,5AG and large-for-gestational age in all three trimesters, but overall, 1,5AG was not a strong predictor of most other relevant outcomes. 39 1,5AG was also affected by pre-eclampsia in the third trimester, perhaps due to altered renal function. 39…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 97%

“…39 1,5AG was also affected by pre-eclampsia in the third trimester, perhaps due to altered renal function. 39…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 97%

“…A secondary analysis of our recent CONCEPTT study assessed if continuous glucose monitoring metrics could provide predictive information. 39 Data were gathered from continuous glucose monitoring (minimum 72 h) in each trimester and compared with biochemical markers of glycaemia taken at the same timepoints. We identified that time in range (TIR; 3.5–7.8 mmol/L, expressed as a percentage of daily values), time above range (TAR) and mean glucose all provided predictive information from the first trimester.…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 99%

“…HbA 1c , especially in trimesters 2 and 3, was directly associated with multiple pregnancy outcomes, including preterm birth, large-for-gestational age, neonatal hypoglycaemia and admission to NICU. 39 HbA 1c has also been associated with important adverse events including stillbirth and congenital anomalies. 6 Despite the many factors which influence HbA 1c concentration in pregnancy, and the resulting limitations, it remains a useful predictive tool.…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 99%

“…No other single marker was able to improve upon the global predictive capability of HbA 1c in pregnancy. 39…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 99%

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Monitoring motherhood: Monitoring and optimizing glycaemia in women with pre-existing diabetes in pregnancy

Meek

2021

Ann Clin Biochem

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Despite recent advances in care, women with diabetes in pregnancy are still at increased risk of multiple pregnancy complications. Offspring exposed to hyperglycaemia in utero also experience long-term health sequelae affecting neurocognitive and cardiometabolic status. Many of these adverse consequences can be prevented or ameliorated with good medical care, specifically to optimise glycaemic control. The accurate assessment of glycaemia in pregnancy is therefore vital to safeguard the health of mother and child. However, there is no consensus about the best method of monitoring glycaemic control in pregnancy. Short-term changes in insulin dosage and lifestyle, with altered appetite, insulin sensitivity and red cell turnover create difficulties in interpretation of standard laboratory measures such as HbA1c. The ideal marker would provide short-term feedback on daily or weekly glycaemic control, with additional capability to predict pregnancies at high risk of suboptimal outcomes. Several novel biochemical markers are available which allow assessment of dynamic changes in glycaemia over weeks rather than months. Continuous glucose monitoring devices have advanced in accuracy and provide new opportunities for robust assessment of glycaemia in pregnancy. Recent work from the continuous glucose monitoring in pregnant women with type 1 diabetes trial (CONCEPTT) has provided information about the ability of different markers of glycaemia to predict pregnancy outcomes. The aim of this review is to summarise the care for women with pre-existing diabetes in pregnancy, and to highlight the important role of glycaemic monitoring in pregnancy.

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Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 97%

“…39 1,5AG was also affected by pre-eclampsia in the third trimester, perhaps due to altered renal function. 39…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 97%

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 99%

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 99%

“…No other single marker was able to improve upon the global predictive capability of HbA 1c in pregnancy. 39…”

Section: Monitoring Of Glycaemic Control In Pregnancymentioning

confidence: 99%

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Monitoring motherhood: Monitoring and optimizing glycaemia in women with pre-existing diabetes in pregnancy

Meek

2021

Ann Clin Biochem

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A pregnancy‐specific Glucose management indicator derived from continuous glucose monitoring in pregnant women with type 1 diabetes

Ling

Yang

Wang

et al. 2023

Diabetes Metabolism Res

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ObjectiveGlucose management indicator (GMI) is a core metric derived from continuous glucose monitoring (CGM) and is widely used to evaluate glucose control in patients with diabetes. No study has explored the pregnancy‐specific GMI. This study aimed to derive a best‐fitting model to calculate GMI from mean blood glucose (MBG) obtained from CGM among pregnant women with type 1 diabetes mellitus (T1DM).MethodsA total of 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM in the CARNATION study were analysed in this study. Continuous glucose monitoring data were collected to calculate MBG, time‐in‐range (TIR), and glycaemic variability parameters. The relationships between the MBG and HbA1c during pregnancy and postpartum were explored. Mix‐effect regression analysis with polynomial terms and cross‐validation method was conducted to investigate the best‐fitting model to calculate GMI from MBG obtained by CGM.ResultsThe pregnant women had a mean age of 28.9 ± 3.8 years, with a diabetes duration of 8.8 ± 6.2 years and a mean body mass index (BMI) of 21.1 ± 2.5 kg/m2. The HbA1c levels were 6.1 ± 1.0% and 6.4 ± 1.0% during pregnancy and at postpartum (p = 0.024). The MBG levels were lower during pregnancy than those at postpartum (6.5 ± 1.1 mmol/L vs. 7.1 ± 1.5 mmol/L, p = 0.008). After adjusting the confounders of haemoglobin (Hb), BMI, trimesters, disease duration, mean amplitude of glycaemic excursions and CV%, we developed a pregnancy‐specific GMI‐MBG equation: GMI for pregnancy (%) = 0.84–0.28* [Trimester] + 0.08 * [ BMI in kg/m2 ] + 0.01 * [Hb in g/mL] + 0.50 * [MBG in mmol/L].ConclusionsWe derived a pregnancy‐specific GMI equation, which should be recommended for antenatal clinical care.Clinical trial registry numberChiCTR1900025955.

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Preconception episodes of severe hypoglycemia and risk of adverse pregnancy outcomes in pregnant women with type 1 diabetes mellitus

Gong,

Luo,

Shi

et al. 2023

Diabetes Metabolism Res

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AimsTo explore the relationship between preconception severe hypoglycemia (PSH) and pregnancy outcomes in pregnancies complicated with type 1 diabetes mellitus (T1DM).Materials and MethodsIn this multicenter prospective cohort study, women with pregestational T1DM were stratified by episodes of severe hypoglycemia within 1 year before conception: No PSH, sporadic PSH (1–6 times/year), and recurrent PSH (>6 times/year). We analysed the predictive ability of PSH for maternal and neonatal outcomes using log‐binomial regression models and receiver operating characteristic (ROC) curve.ResultsOf the 124 women studied, 37.1% experienced at least one episode of severe hypoglycemia preconception. In the multiple adjusted regression models, recurrent PSH was significantly associated with increased incidence of preeclampsia (RR 17.59, 95% CI: 2.89–150.62, p for trend = 0.007), preterm birth (RR 6.34, 95% CI: 1.22–40.63, p for trend = 0.027), neonatal hypoglycemia (RR 4.52, 95% CI: 1.14–17.16, p for trend = 0.017), neonatal hyperbilirubinemia (RR 4.12, 95% CI: 1.11–15.56, p for trend = 0.004), and composite neonatal outcome (RR 3.85, 95% CI: 1.01–19.61, p for trend = 0.003). In the ROC analysis, PSH predicted preeclampsia, preterm birth, neonatal hypoglycemia, neonatal hyperbilirubinemia, and composite neonatal outcome with areas under the ROC curve all ≥0.6.ConclusionsRecurrent preconception severe hypoglycemia is associated with increased risks of adverse outcomes in pregnant women with T1DM.

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Novel Biochemical Markers of Glycemia to Predict Pregnancy Outcomes in Women With Type 1 Diabetes

Abstract: This is a repository copy of Novel biochemical markers of glycemia to predict pregnancy outcomes in women with type 1 diabetes.

Cited by 44 publications

References 40 publications

Monitoring motherhood: Monitoring and optimizing glycaemia in women with pre-existing diabetes in pregnancy

Monitoring motherhood: Monitoring and optimizing glycaemia in women with pre-existing diabetes in pregnancy

A pregnancy‐specific Glucose management indicator derived from continuous glucose monitoring in pregnant women with type 1 diabetes

Preconception episodes of severe hypoglycemia and risk of adverse pregnancy outcomes in pregnant women with type 1 diabetes mellitus

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