Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

Meek, Claire L; Corcoy, Rosa; Asztalos, Elizabeth; Kusinski, Laura C.; Lopez, Esther; Feig, Denice S.; Murphy, Helen

doi:10.1186/s12884-021-03554-6

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Gestational age was based upon last menstrual period (or early pregnancy ultrasound when discordant). Grow centiles were calculated using version 8 of the GROW calculator 15,16 . Fisher's and Cochran's Q tests were used to address differences in UCPCR positivity between study periods.…”

Section: Participants and Methodsmentioning

confidence: 99%

Pregnancy induces longitudinal changes in urinary C‐peptide creatinine ratio in women with type 1 diabetes

et al. 2023

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AimsChanges in maternal serum C‐peptide have been described during pregnancy in women with Type 1 diabetes. We aimed to determine whether in these women, C‐peptide, as measured by the urinary C‐peptide creatinine ratio (UCPCR), display changes during the course of pregnancy and in the postpartum period.MethodsIn this longitudinal study including 26 women, UCPCR was measured in the first, second, and third trimester of pregnancy, and postpartum, using a high sensitivity two‐step chemiluminescent microparticle immunoassay.ResultsUCPCR was detectable in 7/26 (26.9%) participants in the first trimester, 10/26 (38.4%) in the second trimester, and 18/26 (69.2%) in the third trimester. Changes in UCPCR concentrations were observed throughout pregnancy, significantly increasing from first to third trimester. UCPCR concentration in the three trimesters was associated with a shorter duration of diabetes and in the third trimester also with first trimester UCPCR.ConclusionUCPCR detects longitudinal changes during pregnancy in women with type 1 diabetes mellitus, more marked in those with shorter diabetes duration.

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Section: Participants and Methodsmentioning

confidence: 99%

Pregnancy induces longitudinal changes in urinary C‐peptide creatinine ratio in women with type 1 diabetes

et al. 2023

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“…The CONCEPTT collaborative group published the main article in 2017 ( 5 ); however, there continues to be a plethora of subanalyses ( 10 – 25 ) to glean more insight into the optimal care of this special population that is underrepresented in research. Our objective is to provide a comprehensive review of the findings of the CONCEPTT collaborative group’s primary analysis ( 5 ) and subanalyses ( 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ) so as to provide a summary of all of the group’s published findings presented in one publication. We searched PubMed for articles published with restrictions to English language with the search terms ‘type 1 diabetes’ and ‘pregnancy’ and ‘continuous glucose monitor’ and ‘women’ and ‘CONCEPTT’.…”

Section: Introductionmentioning

confidence: 99%

“…We searched PubMed for articles published with restrictions to English language with the search terms ‘type 1 diabetes’ and ‘pregnancy’ and ‘continuous glucose monitor’ and ‘women’ and ‘CONCEPTT’. We identified 17 articles including a protocol summary ( 10 ), the main article ( 5 ) and 15 subanalyses ( 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ). The subanalyses reviewed seven general concepts: (i) are insulin pumps better than MDI in neonatal and maternal outcomes?…”

Section: Introductionmentioning

confidence: 99%

“… 10. Meek et al BMC Pregnancy Childbirth 2021 ( 18 ) Prespecified analysis of the rates of LGA and SGA offspring in the CONCEPTT study population ( n = 225 pregnant women and liveborn infants) Evaluate what growth standard was most appropriate to predict LGA in women with T1D in pregnancy. GROW and INTERGROWTH birth percentiles were more strongly associated with neonatal complications, WHO standards may not be appropriate for pregnancies complicated by T1D, as they were designed to identify SGA in a mixed population.…”

Section: Introductionmentioning

confidence: 99%

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A review of CONCEPTT study findings including subanalyses in pregnant women using continuous glucose monitoring with type 1 diabetes and their offspring

Pham,

Thorsell,

Castorino

et al. 2023

Endocrine Connections

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The main objective of this manuscript is to provide a comprehensive review of continuous glucose monitoring use in pregnant women with type 1 diabetes from the CONCEPTT study including sub-analyses. Literature search was accessed through MEDLINE (1966 – September 2023) using the key terms: CONCEPTT, pregnancy, women, type 1 diabetes, and continuous glucose monitor with imitations set to distinguish human subjects written in English. A total of 17 publications including one main clinical trial and 15 sub-analyses have been published to date regarding the use of CGM in pregnant women with T1D which were conducted by a research group identified as the CONCEPTT Collaborative Group. While advances in maternal care have resulted in safer pregnancy for both the mother and child, women with pre-existing T1D and pregnancy still experience higher rates of complications both short and long term. The use of CGM in pregnancy has not been studied extensively until more recently. The CONCEPTT clinical trial was a landmark study that involved several sub analyses. The main trial proved that CGM use in T1D pregnancy resulted in less hyperglycemia in the 3rd trimester, reduced large for gestational age (LGA, >90th centile), reduced neonatal intensive care unit (NICU) admissions lasting longer than 24 hours, and reduced neonatal hypoglycemia. Although sub analyses showed a variety of results including “inconclusive” due to lack of pre-specification, it is believed that CGM in T1D during pregnancy is to be recommended and used for overall improved outcomes.

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“…The proportion of small-forgestational-age (SGA) neonates born to women with type 1 diabetes remained stable at around 3-4% up to 2010 in Denmark [9,10], with a small increase to 6-7% in the last 10 years [11]. In a recent large multicentre trial, rates of LGA offspring were 62-65% and of SGA offspring were 1-2%, depending which growth chart was used [12].…”

Section: Introductionmentioning

confidence: 99%

Secular trend for increasing birthweight in offspring of pregnant women with type 1 diabetes: is improved placentation the reason?

et al. 2022

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Despite enormous progress in managing blood glucose levels, pregnancy in women with type 1 diabetes still carries risks for the growing fetus. While, previously, fetal undergrowth was not uncommon in these women, with improved maternal glycaemic control we now see an increased prevalence of fetal overgrowth. Besides short-term implications, offspring of women with type 1 diabetes are more likely to become obese and to develop diabetes and features of the metabolic syndrome. Here, we argue that the increase in birthweight is paradoxically related to improved glycaemic control in the pre- and periconceptional periods. Good glycaemic control reduces the prevalence of microangiopathy and improves placentation in early pregnancy, which may lead to unimpeded fetal nutrition. Even mild maternal hyperglycaemia may then later result in fetal overnutrition. This notion is supported by circumstantial evidence that lower HbA1c levels as well as increases in markers of placental size and function in early pregnancy are associated with large-for-gestational age neonates. We also emphasise that neonates with normal birthweight can have excessive fat deposition. This may occur when poor placentation leads to initial fetal undergrowth, followed by fetal overnutrition due to maternal hyperglycaemia. Thus, the complex interaction of glucose levels during different periods of pregnancy ultimately determines the risk of adiposity, which can occur in fetuses with both normal and elevated birthweight. Prevention of fetal adiposity calls for revised goal setting to enable pregnant women to maintain blood glucose levels that are closer to normal. This could be supported by continuous glucose monitoring throughout pregnancy and appropriate maternal gestational weight gain. Future research should consider the measurement of adiposity in neonates. Graphical abstract

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

Cited by 8 publications

References 24 publications

Pregnancy induces longitudinal changes in urinary C‐peptide creatinine ratio in women with type 1 diabetes

Pregnancy induces longitudinal changes in urinary C‐peptide creatinine ratio in women with type 1 diabetes

A review of CONCEPTT study findings including subanalyses in pregnant women using continuous glucose monitoring with type 1 diabetes and their offspring

Secular trend for increasing birthweight in offspring of pregnant women with type 1 diabetes: is improved placentation the reason?

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