Abstract
Objective
Our aim in this study was to compare the effects of risk factors for large-for-gestational-age
(LGA) birthweight between women with type 1 and type 2 diabetes mellitus (TIDM and
T2DM, respectively).
Methods
A retrospective cohort study was conducted for women with T1DM (n=152) and T2DM (n=255)
attending a diabetes/pregnancy clinic during the period from 2009 to 2016. Multiple
logistic regression analysis was used to identify variables associated with LGA birthweight.
Results
LGA was significantly higher in those with T1DM (39%) than T2DM (17%) (p<0.001). Among
those with T1DM, there was a nonsignificant association between LGA and continuous
subcutaneous insulin infusion (odds ratio, 1.17; 95% confidence interval, 0.99 to
1.39; p=0.06) and excess maternal weight gain (T1DM odds ratio, 1.19; 95% confidence
interval, 0.99 to 1.43; p=0.069). In those with T2DM, there was an association between
LGA and glycated hemoglobin at delivery (T2DM odds ratio, 1.10; 95% confidence interval,
1.02 to 1.19; p=0.01).
Conclusions
In the study population, glycemic control at delivery was predictive of LGA in women
with T2DM, and there was a trend toward an association of maternal weight gain and
continuous subcutaneous insulin infusion with LGA infants in T1DM. Further study is
warranted to better guide targeted interventions to reduce high rates of LGA birthweight
in T1DM/T2DM.
RÉSUMÉ
Objectif
Notre objectif dans cette étude était de comparer les effets des facteurs de risque
pour le poids à la naissance lors d'une macrosomie fœtale (MF) entre les femmes atteintes
de diabète sucré de type 1 et de type 2 (DST1 et DST2, respectivement).
Méthodes
Une étude de cohorte rétrospective a été menée auprès de femmes atteintes de DST1
(n=152) et de DST2 (n=255) qui ont fréquenté une clinique du diabète/de grossesse
entre 2009 et 2016. Une analyse de régression logistique multinomiale a été utilisée
pour identifier les variables associées au poids à la naissance de la MF.
Résultats
La MF était significativement plus élevée pour les femmes atteintes de DST1 (39%)
que chez celles atteintes du DST2 (17%) (p<0.001). Chez celles atteintes du DST1,
une association non significative a été observée entre la MF et la perfusion sous-cutanée
continue d'insuline (rapport de cotes, 1.17; intervalle de confiance à 95%, 0.99 à
1.39; p=0.06) et le gain de poids excessif chez la mère (rapport de cotes DST1, 1.19;
intervalle de confiance à 95%, 0.99 à 1.43; p=0.069). Chez les femmes atteintes de
DST2, il y avait une association entre la MF et l'hémoglobine glyquée à l'accouchement
(rapport de cotes pour le DST2, 1.10; intervalle de confiance à 95%, 1.02 à 1.19;
p=0.01).
Conclusions
Dans la population de l'étude, le contrôle glycémique à l'accouchement était prédictif
de la MF chez les femmes atteintes de DST2, et une tendance a été observée vers une
association du gain de poids maternel et de la perfusion sous-cutanée continue d'insuline
avec la MF infantile en cas de DST1. Une autre étude demeure nécessaire pour mieux
orienter les interventions ciblées visant à réduire les taux élevés de poids à la
naissance lors de MF dans les cas de DST1/DST2.
Keywords
Mots clés
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References
- Pre-pregnancy care for women with pre-gestational diabetes mellitus: A systematic review and meta-analysis.BMC Public Health. 2012; 12: 792
- Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: Benefits beyond glycemic control.Diabetes Care. 2010; 33: 2514-2520
- Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects.Endocrine. 2011; 40: 243-249
- Fetal overgrowth in women with type 1 and type 2 diabetes mellitus.PLoS One. 2017; 12: e0187917
- Outcomes in type 1 diabetic pregnancies: A nationwide, population-based study.Diabetes Care. 2004; 27: 2819-2823
- Diabetic fetal macrosomia: Significance of disproportionate growth.J Pediatr. 1993; 122: 115-119
- Can shoulder dystocia be predicted? Preconceptive and prenatal factors.J Reprod Med. 1998; 43: 654-658
- Macrosomia in infants of insulin-dependent diabetic mothers.Pediatrics. 1989; 83: 1029-1034
- Fetal growth in women managed with insulin pump therapy compared to conventional insulin.Eur J Obstet Gynecol Reprod Biol. 2008; 137: 47-49
- Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: A prospective nationwide study.Diabetologia. 2017; 60: 1668-1677
- Effect of excess gestational weight gain on pregnancy outcomes in women with type 1 diabetes.Obstet Gynecol. 2014; 123: 1295-1302
- Maternal glycated haemoglobin, pre-gestational weight, pregnancy weight gain and risk of large-for-gestational-age babies: A Danish cohort study of 209 singleton Type 1 diabetic pregnancies.Diabet Med. 2007; 24: 384-387
- Near-optimal glycemic control in Chilean women with pregestational type-2 diabetes: Persistent macrosomia relates to maternal pre-pregnancy overweight.Diabetes Res Clin Pract. 2009; 85: 53-60
- Risk factors associated with altered fetal growth in patients with pregestational diabetes mellitus.J Matern Fetal Neonatal Med. 2012; 25: 1390-1394
- Fetal growth in relation to gestational weight gain in women with type 2 diabetes: An observational study.Diabet Med. 2014; 31: 1681-1689
- Customised antenatal growth charts.Lancet. 1992; 339: 283-287
- A new and improved population-based Canadian reference for birth weight for gestational age.Pediatrics. 2001; 108: E35
Gardosi J. Gestation network. Customised weight centile calculator. GROW v8.1 UK. http://www.gestation.net/birthweight_centiles/centile_object.htm. Accessed July 26, 2019.
- Weight Gain During Pregnancy: Reexamining the Guidelines.National Academies Press, Washington2009
- mice: Multivariate Imputation by Chained Equations in R.J Stat Softw. 2011; 45: 1-67
- The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: A population based study.BMC Pregnancy Childbirth. 2004; 4: 17
- Diabetes and pregnancy.Can J Diabetes. 2018; 42: S255‒82
- Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control.Endocrine. 2017; 55: 447-455
- Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes.BMC Pregnancy Childbirth. 2016; 16: 162
- The effect of glycemic control in the pre-conception period and early pregnancy on birth weight in women with IDDM.Diabetes Care. 1998; 21: 535-538
- What proportion of birth weight is attributable to maternal glucose among infants of diabetic women?.Am J Obstet Gynecol. 2006; 194: 501-507
- Episodic hyperglycaemia in pregnant women with well-controlled Type 1 diabetes mellitus: A major potential factor underlying macrosomia.Diabet Med. 1999; 16: 702-706
- Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands.Diabetologia. 2002; 45: 1484-1489
- Analysis of continuous glucose monitoring in pregnant women with diabetes: Distinct temporal patterns of glucose associated with large-for-gestational-age infants.Diabetes Care. 2015; 38: 1319-1325
- Poor glucose control in women with type 1 diabetes mellitus and 'safe' hemoglobin A1c values in the first trimester of pregnancy.J Matern Fetal Neonatal Med. 2003; 13: 309-313
- Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): A multicentre international randomised controlled trial.Lancet. 2017; 390: 2347-2359
- Effectiveness of continuous glucose monitoring in pregnant women with diabetes: Randomised clinical trial.BMJ. 2008; 337: a1680
- Heterogeneity of fetal growth in type 1 diabetic pregnancy.Diabetes Metab. 2001; 27: 339-344
- Comparative effectiveness of continuous subcutaneous insulin infusion using insulin analogs and multiple daily injections in pregnant women with diabetes mellitus: A systematic review and meta-analysis.J Womens Health (Larchmt). 2015; 24: 237-249
- Continuous subcutaneous insulin infusion vs multiple daily injections in pregnant women with type 1 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials and observational studies.Eur J Endocrinol. 2018; 178: 545-563
- Diabetes and pregnancy.Can J Diabetes. 2008; 32: S168-S180
- Diabetes and pregnancy.Can J Diabetes. 2013; 37: S168-S183
Article Info
Publication History
Published online: September 04, 2019
Accepted:
August 19,
2019
Received in revised form:
July 30,
2019
Received:
March 14,
2019
Identification
Copyright
© 2019 Canadian Diabetes Association.
