Advertisement

Predictors of Large-for-Gestational-Age Birthweight Among Pregnant Women With Type 1 and Type 2 Diabetes: A Retrospective Cohort Study

  • Lisa D. Alexander
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • George Tomlinson
    Affiliations
    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Denice S. Feig
    Correspondence
    Address for correspondence: Denice S. Feig MD, Department of Medicine, University Health Network Mount Sinai Hospital, 60 Murray Street, #5027, Toronto, Ontario M5T 3L9, Canada.
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Endocrinology & Metabolism and the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
    Search for articles by this author
Published:September 04, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.08.015

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wahabi H.A.
        • Alzeidan R.A.
        • Esmaeil S.A.
        Pre-pregnancy care for women with pre-gestational diabetes mellitus: A systematic review and meta-analysis.
        BMC Public Health. 2012; 12: 792
        • Murphy H.R.
        • Roland J.M.
        • Skinner T.C.
        • et al.
        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
        • Cyganek K.
        • Hebda-Szydlo A.
        • Skupien J.
        • et al.
        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
        • Ladfors L.
        • Shaat N.
        • Wiberg N.
        • Katasarou A.
        • Berntorp K.
        • Kristensen K.
        Fetal overgrowth in women with type 1 and type 2 diabetes mellitus.
        PLoS One. 2017; 12: e0187917
        • Jensen D.M.
        • Damm P.
        • Moelsted-Pedersen L.
        • et al.
        Outcomes in type 1 diabetic pregnancies: A nationwide, population-based study.
        Diabetes Care. 2004; 27: 2819-2823
        • Ballard J.L.
        • Rosenn B.
        • Khoury J.C.
        • Miodovnik M.
        Diabetic fetal macrosomia: Significance of disproportionate growth.
        J Pediatr. 1993; 122: 115-119
        • Lewis D.F.
        • Edwards M.S.
        • Asrat T.
        • Adair C.D.
        • Brooks G.
        • London S.
        Can shoulder dystocia be predicted? Preconceptive and prenatal factors.
        J Reprod Med. 1998; 43: 654-658
        • Berk M.A.
        • Mimouni F.
        • Miodovnik M.
        • Hertzberg V.
        • Valuck J.
        Macrosomia in infants of insulin-dependent diabetic mothers.
        Pediatrics. 1989; 83: 1029-1034
        • Kernaghan D.
        • Farrell T.
        • Hammond P.
        • Owen P.
        Fetal growth in women managed with insulin pump therapy compared to conventional insulin.
        Eur J Obstet Gynecol Reprod Biol. 2008; 137: 47-49
        • Murphy H.R.
        • Bell R.
        • Cartwright C.
        • et al.
        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
        • Scifres C.M.
        • Feghali M.N.
        • Althouse A.D.
        • Caritis S.N.
        • Catov J.M.
        Effect of excess gestational weight gain on pregnancy outcomes in women with type 1 diabetes.
        Obstet Gynecol. 2014; 123: 1295-1302
        • Nielsen G.L.
        • Dethlefsen C.
        • Møller M.
        • Sørensen H.T.
        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
        • Olmos P.R.
        • Araya-Del-Pino A.P.
        • González-Carvello C.A.
        • et al.
        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
        • Kanda E.
        • Matsuda Y.
        • Makino Y.
        • Matsui H.
        Risk factors associated with altered fetal growth in patients with pregestational diabetes mellitus.
        J Matern Fetal Neonatal Med. 2012; 25: 1390-1394
        • Parellada C.B.
        • Asbjörnsdóttir B.
        • Ringholm L.
        • Damm P.
        • Mathiesen E.R.
        Fetal growth in relation to gestational weight gain in women with type 2 diabetes: An observational study.
        Diabet Med. 2014; 31: 1681-1689
        • Gardosi J.
        • Chang A.
        • Kalyan B.
        • Sahota D.
        • Symonds E.M.
        Customised antenatal growth charts.
        Lancet. 1992; 339: 283-287
        • Kramer M.S.
        • Platt R.W.
        • Wen S.W.
        • et al.
        A new and improved population-based Canadian reference for birth weight for gestational age.
        Pediatrics. 2001; 108: E35
      1. 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.

        • Rasmussen K.
        • Yaktine A.
        Weight Gain During Pregnancy: Reexamining the Guidelines.
        National Academies Press, Washington2009
        • van Buuren S.
        • Groothuis-Oudshoorn K.
        mice: Multivariate Imputation by Chained Equations in R.
        J Stat Softw. 2011; 45: 1-67
        • Allen V.M.
        • Joseph K.
        • Murphy K.E.
        • Magee L.A.
        • Ohlsson A.
        The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: A population based study.
        BMC Pregnancy Childbirth. 2004; 4: 17
        • Feig D.S.
        • Berger H.
        • Donovan L.
        • et al.
        • Diabetes Canada Clinical Practice Guidelines Expert Committee
        Diabetes and pregnancy.
        Can J Diabetes. 2018; 42: S255‒82
        • Cyganek K.
        • Skupien J.
        • Katra B.
        • et al.
        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
        • Morrens A.
        • Verhaeghe J.
        • Vanhole C.
        • Devlieger R.
        • Mathieu C.
        • Benhalima K.
        Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes.
        BMC Pregnancy Childbirth. 2016; 16: 162
        • Gold A.E.
        • Reilly R.
        • Little J.
        • Walker J.D.
        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
        • Sacks D.A.
        • Liu A.I.
        • Wolde-Tsadik G.
        • Amini S.B.
        • Huston-Presley L.
        • Catalano P.M.
        What proportion of birth weight is attributable to maternal glucose among infants of diabetic women?.
        Am J Obstet Gynecol. 2006; 194: 501-507
        • Kyne-Grzebalski D.
        • Wood L.
        • Marshall S.M.
        • Taylor R.
        Episodic hyperglycaemia in pregnant women with well-controlled Type 1 diabetes mellitus: A major potential factor underlying macrosomia.
        Diabet Med. 1999; 16: 702-706
        • Evers I.M.
        • de Valk H.W.
        • Mol B.W.
        • ter Braak E.W.
        • Visser G.H.
        Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands.
        Diabetologia. 2002; 45: 1484-1489
        • Law G.R.
        • Ellison G.T.
        • Secher A.L.
        • et al.
        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
        • Kerssen A.
        • Evers I.M.
        • de Valk H.W.
        • Visser G.H.
        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
        • Feig D.S.
        • Donovan L.E.
        • Corcoy R.
        • et al.
        Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): A multicentre international randomised controlled trial.
        Lancet. 2017; 390: 2347-2359
        • Murphy H.R.
        • Rayman G.
        • Lewis K.
        • et al.
        Effectiveness of continuous glucose monitoring in pregnant women with diabetes: Randomised clinical trial.
        BMJ. 2008; 337: a1680
        • Lepercq J.
        • Taupin P.
        • Dubois-Laforgue D.
        • et al.
        Heterogeneity of fetal growth in type 1 diabetic pregnancy.
        Diabetes Metab. 2001; 27: 339-344
        • Ranasinghe P.D.
        • Maruthur N.M.
        • Nicholson W.K.
        • et al.
        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
        • Rys P.M.
        • Ludwig-Slomczynska A.H.
        • Cyganek K.
        • Malecki M.T.
        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
        • Thompson D.
        • Capes S.
        • Feig D.
        Diabetes and pregnancy.
        Can J Diabetes. 2008; 32: S168-S180
        • Thompson D.
        • Berger H.
        • Feig D.
        • et al.
        Diabetes and pregnancy.
        Can J Diabetes. 2013; 37: S168-S183