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

Klemetti, Miira M.; Nuutila, Mika; Tikkanen, Minna; Kari, M. Anneli; Hiilesmaa, Vilho; Teramo, Kari

doi:10.1007/s00125-012-2627-9

Cited by 66 publications

(83 citation statements)

References 43 publications

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“…The decrease in the elective CS rate among women with diabetic nephropathy is in line with our observations concerning delivery mode trends in all type 1 diabetes patients during 1989-2008 [25]. Changes in the management of type 1 diabetes pregnancies in HUCH are likely to explain these trends as until year 2000 the delivery mode of choice was CS for all patients with diabetic nephropathy.…”

Section: Discussionsupporting

confidence: 86%

“…The obesity epidemic has not affected women with diabetic nephropathy, whose median BMI has remained in the normal range. This is in contrast to our previous observations in other type 1 diabetes patients [25] and the Finnish background population, in which every third parturient is currently overweight and 13% are obese [26]. The frequency of smoking during pregnancy was higher than the 15-17% recorded in 1987-2010 for all Finnish parturients [27], but similar to the figures reported by Damm et al [4].…”

Section: Discussionsupporting

confidence: 67%

“…Nevertheless, it should be noted that a significant proportion of pregnancies of diabetic nephropathy patients may also be complicated by fetal macrosomia, as shown by our data. However, the macrosomia rates were lower and the SGA rates higher than recently observed in type 1 diabetes patients [2,25]. The relatively high proportion of infants with 1 min Apgar score <7 may be related to the high preterm birth rate.…”

Section: Discussionmentioning

confidence: 62%

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Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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Aims/hypothesis Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988-2011. Methods The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988Two periods, -1999Two periods, and 2000Two periods, -2011 . Antihypertensive medication usage increased before pregnancy (34% vs 65%, p=0.002) and in the second and third trimesters of pregnancy (25% vs 47%, p=0.02, and 36% vs 60%, p =0.01, respectively). BP exceeded 130/ 80 mmHg in 62% and 61% (p=0.87) of patients in the first trimester, and in 95% and 93% (p=0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%, p=0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%, p=0.33, and 71% vs 77%, p=0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (p=0.01) and 29% and 48% (p= 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (p=0.02). Conclusions/interpretation Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 62%

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Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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“…Presently, the prevalence of type 1 diabetes in pregnancy is increasing along with type 2 and gestational diabetes [8][9][10]. Several studies have evaluated the clinical relevance of White's classification [7,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

et al. 2015

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Aims/hypothesis Our aim was to examine the association of White's classification with obstetric and perinatal risk factors and outcomes in type 1 diabetic patients. Methods Obstetric records of a population-based cohort of 1,094 consecutive type 1 diabetic patients with a singleton childbirth during 1988-2011 were studied. The most recent childbirth of each woman was included. Results The prepregnancy and the first trimester HbA 1c increased from White's class B to F (p for trend <0.001). Systolic and diastolic blood pressure and pre-eclampsia frequencies increased stepwise from class B to F (p for trends <0.001).Vaginal deliveries decreased and Caesarean sections and deliveries before 37 weeks increased from class B to F (p for trends <0.001). Fetal macrosomia (p for trend=0.003) decreased and small-for-gestational age infants (p for trend=0.002) and neonatal intensive care unit admissions (p for trend=0.001) increased from class B to F. In logistic regression analysis, White's classes were associated with pre-eclampsia but, with the exception of class R (proliferative retinopathy) and F (nephropathy), not with other adverse outcomes when adjusted for first trimester HbA 1c ≥7% (≥53 mmol/mol) and blood pressure ≥140/90 mmHg. First trimester HbA 1c ≥7% was associated with pre-eclampsia, preterm delivery, fetal macrosomia and neonatal intensive care unit admission. Conclusions/interpretation White's classification is useful in estimating the risk of pre-eclampsia in early pregnancy independently of suboptimal glycaemic control and hypertension. However, its utility in predicting adverse perinatal outcomes seems limited when information on first trimester HbA 1c , blood pressure and diabetic microvascular complications is available.

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“…Özellikle gebelik haftasına göre düşük doğum ağırlıklı bebekler ve insüline bağımlı diyabetik anne bebeklerinin hipoglisemi açısından tetkik edildiği ancak makrozomik bebeklerin gözden kaçtığı bildirilmiştir (18). Romas ve ark.larının (20) (23)(24)(25). Çalışmamızdaki bebeklerin ortalama doğum ağırlığı 3322,5± 695,8 gr bulundu ve makrozomi ilişkili doğum travması görülmedi.…”

Section: Introductionunclassified

Di̇yabeti̇k Anne Bebekleri̇ni̇n Yeni̇doğan Dönemi̇ Sorunlari

Ince¹,

Takçı²,

Gümüşer³

2014

J Contemp Med

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ÖZETAmaç: Diyabet gebelikte fetal gelişimi etkileyen ve yenidoğanlarda metabolik bozukluklara yol açan bir hastalıktır. Çalışmamızda diyabetik anne bebeklerinin yenidoğan sorunlarının ve gebelikte anneye ait risk faktörlerinin değerlendirilmesi amaçlandı.Gereç ve yöntem: Çalışmada Gaziosmanpaşa Üniversitesi Tıp Fakültesi Hastanesinde Ocak 2013-Aralık 2013 tarihleri arasında doğan ve yenidoğan yoğun bakım ünitesinde izlenen 31 diyabetik anne bebeğinin morbidite oranları ve annelere ait demografik özellikleri retrospektif olarak değerlendirildi.Bulgular: Çalışmaya 31 diyabetik anne bebeği alındı. Annelerden 7'si (%22,6) insuline bağımlı diyabet ve 24'ü (%77,4) gestasyonel diyabet tanısı ile takip edilmekte idi. Annelerin ortalama yaşı 32,6±7,9 yıl, ortalama glikolize hemoglobin (HbA1c) değerleri % 5,4±1 (4,2-10,2) saptandı. Bebeklerin ortalama gebelik haftaları 37,5±1,5 hafta, ortalama doğum ağırlığı 3322,5± 695,8 gr. idi. Makrozomi sıklığı %32,2 idi. Bebeklerde hipoglisemi %9,7, hipokalsemi %3,2, polistemi %6,5, anemi %6,5, trombositopeni %9,7, hiperbilirubinemi % 41,9, respiratuvar distres sendromu %12,9, doğuştan anomali %3,7 oranında bulundu. Annenin HbA1c düzeyi ile hipoglisemi, hipokalsemi, polistemi, anemi, respiratuar distres sendromu arasında ilişki bulunmadı (p>0,05).Sonuç: Diyabetik anne bebeklerinde uygun medikal yaklaşım, obstetrik bakım ve neonatal yaklaşım ile komplikasyonlar önlenebilir. Gestasyonel diyabetin tanımlanması, hipergliseminin kontrol altına alınması, risk faktörlerinin belirlenmesi ve yenidoğan yoğun bakımda izlem ihtiyacı olamayan bebeklerin doğumdan sonra ilk saatlerde anne yanına verilmesi ve anne yanında yakın takibi ile morbiditenin azaltılması mümkündür.Anahtar kelimeler: diyabetik anne bebeği, komplikasyon ABSTRACT Objectives: Diabetes is a disease that effects fetal development during pregnancy and leads metabolic disorders in newborns. In this study, we aimed to evaluate the problems of infants of diabetic mothers and to determine risk factors of mothers during pregnancy. Material and Methods:The morbidity rates of 31 infants of diabetic mothers who were born and followed in neonatal intensive unit between January 2013 and December 2013 at Gaziosmanpasa University and demographic properties of mothers were retrospectively evaluated.Results: A total of 31 infants were included. The incidence of insulin dependent diabetes mellitus was %22,6 and the incidence of gestational diabetes was 77,4%. Mothers' mean age was 32,6±7,9 years and HbA1c level was 5,4±1 (4,2-10,2). The mean gestational age of infants was 37,5±1,5 weeks and the mean birth weight of infants was 3322,5± 695,8 g. Macrosomia was present in 32.2% of infants. Hypoglycemia was present in 9,7% of infants, hypocalcemia was seen 3.2%, polycytemia was seen 6.5%, anemia was seen 6.5%, thrombocytopenia was seen 9.2%, hyperbilirubinemia was seen 41.9%, respiratory distress syndrome was seen 12.9%, congenital anomaly was seen 3.7% of all infants. There was no correlation between HbA1c levels of mothers and hypoglycemia, hypoca...

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

Cited by 66 publications

References 43 publications

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

Di̇yabeti̇k Anne Bebekleri̇ni̇n Yeni̇doğan Dönemi̇ Sorunlari

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