Peri-Conceptional A1C and Risk of Serious Adverse Pregnancy Outcome in 933 Women With Type 1 Diabetes

Jensen, Dorte Møller; Korsholm, Lars; Ovesen, Per; Beck‐Nielsen, Henning; Moelsted-Pedersen, Lars; Westergaard, J.G.; Moeller, Margrethe; Damm, Peter

doi:10.2337/dc08-2061

Cited by 204 publications

(130 citation statements)

References 13 publications

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“…Therefore, efforts should be made to increase attendance at prepregnancy clinics. The observation that poor glycaemic control in early pregnancy continues in late pregnancy is important and consistent with previous studies, which have shown that high HbA 1c values in early pregnancy are associated with adverse perinatal outcomes [28][29][30].…”

Section: Discussionsupporting

confidence: 74%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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Aims/hypothesis Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome. Methods We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother. Results Maternal BMI increased significantly during 1989-2008 (p<0.001). The mean HbA 1c in the first trimester remained unchanged, but the midpregnancy and the last HbA 1c before delivery increased (p00.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA 1c value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia. Conclusions/interpretation Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.

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Section: Discussionsupporting

confidence: 74%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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“…In the present epidemiological study, we did not find an association between HbA 1c and endocrine diseases on an ICD-10 chapter level. In the original work describing adverse pregnancy outcome in the deliveries between 1993 and 1999, Jensen et al (13) described an increased risk of congenital malformations with maternal periconceptional HbA 1c $10.4 compared with the background population. In the current study, we found no significant association between HbA 1c and congenital malformations among the index children.…”

Section: Discussionmentioning

confidence: 99%

“…Maternal HbA 1c levels in pregnancy have been shown to be positively associated with adverse fetal outcome, but whether maternal HbA 1c levels affect long-term offspring outcome remains to be determined (13,14).…”

mentioning

confidence: 99%

Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study

et al. 2015

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OBJECTIVEThis study examined the long-term consequences for offspring born to mothers with pregestational type 1 diabetes regarding mortality, hospital admissions, and medication. We also examined the association between HbA 1c levels during pregnancy and mortality and incidence of hospital admissions. RESEARCH DESIGN AND METHODSWe performed a prospective combined clinical and register-based cohort study comparing mortality, hospital admissions, and use of medication in offspring (n = 1,326) of women with pregestational type 1 diabetes (index children) with matched control subjects (n = 131,884). We also examined the association between HbA 1c levels during pregnancy and mortality and the incidence of hospital admissions. Participants were monitored from birth to the age of 13-21 years. RESULTSOverall mortality was significantly increased for index children (hazard ratio 2.10, 95% CI 1.33-3.30, P = 0.001). The incidence of hospital admissions for index children was significantly increased (incidence rate ratio [IRR] 1.45, 95% CI 1.38-1.53, P < 0.001), and this was the case for all age groups until the age of 15 years. The incidence of hospital admissions among index children was positively associated with maternal HbA 1c before pregnancy and in the first trimester. In addition, the overall use of medication was increased in index children (IRR 1.13, 95% CI 1.07-1.19, P < 0.001). CONCLUSIONSType 1 diabetes during pregnancy has long-term implications on the health of offspring, with increased mortality, incidence of hospital admissions, and use of medication. Among mothers with type 1 diabetes, glycemic regulation is positively associated with incidence of hospital admissions in offspring.Women with type 1 diabetes have an increased risk of adverse pregnancy outcome, including stillbirth, perinatal mortality, and congenital malformations (1-4). However, studies concerning long-term offspring outcome are sparse and results conflicting. Some studies have demonstrated an increased risk of type 2 diabetes and obesity, whereas others have found no association with BMI, glucose, insulin, or

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“…The association of poor glycaemic control with untoward perinatal outcome has been established for congenital malformations [1,2], miscarriage [3], perinatal mortality [4], pre-eclampsia [5], increased birthweight [6], neonatal hypoglycaemia [7] and respiratory distress [8], among others.…”

Section: Introductionmentioning

confidence: 99%

Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction

et al. 2009

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Aims/hypothesis The aim of the study was to analyse the insulin requirements of women with type 1 diabetes mellitus throughout pregnancy. Methods We have examined the weekly mean blood glucose (mmol/l), insulin requirements (U kg −1 day −1 ) and total insulin requirements (U/day) in 65 women with type 1 diabetes mellitus and tight metabolic control since before pregnancy (HbA 1c ≤6.0%).Results Both insulin requirement and total insulin requirement displayed a peak in week 9, a nadir in week 16 and a second peak in week 37. For the change in insulin requirement (4.08% per week) and in total insulin requirement (5.19% per week), the sharpest slope was observed from week 16 to week 37. However, two changes of direction took place in the first 11 weeks and eight out of nine episodes of severe hypoglycaemia requiring treatment with glucagon or i.v. glucose took place in the first 16 weeks. Conclusions/interpretation Pregnant women with type 1 diabetes mellitus and tight metabolic control since before pregnancy displayed changes in insulin requirement and total insulin requirement with successive changes of direction. The sharpest slope was observed between 16 and 37 weeks, but insulin requirements were more unstable in the first 16 weeks. This information could help patients and physicians to react to changes in glycaemic pattern in a prompt and adequate way.

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Peri-Conceptional A1C and Risk of Serious Adverse Pregnancy Outcome in 933 Women With Type 1 Diabetes

Cited by 204 publications

References 13 publications

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study

Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction

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