HbA(1c) and Birthweight in Women with Pre-conception Type 1 and Type 2 Diabetes: a Population-based Cohort Study

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2012 Sep 28

PMID 23015260

Citations 34

Authors

S V Glinianaia

P W G Tennant

R W Bilous

J Rankin

R Bell

Affiliations

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Abstract

Aims/hypothesis: To investigate clinical and sociodemographic predictors of birthweight in singletons born to women with type 1 or type 2 diabetes.

Methods: Normally formed singleton live births and intrapartum stillbirths, born to women with pre-conception diabetes during 1996-2008, were identified from the population-based Northern Diabetes in Pregnancy Survey (n = 1,505). Associations between potential predictors and birthweight were analysed by multiple regression.

Results: Potentially modifiable independent predictors of increase in birthweight were pre-pregnancy care (adjusted regression coefficient [b] = 87.1 g; 95% CI 12.9, 161.3), increasing third-trimester HbA(1c) ≤7% (53 mmol/mol) (b = 310.5 g per 1% [11 mmol/mol]; 95% CI 246.3, 374.7) and increasing maternal BMI (b = 9.5 g per 1 kg/m(2); 95% CI 3.5, 15.5). Smoking during pregnancy (b = -145.1 g; 95% CI -231.4, -58.8), later gestation at first antenatal visit (b = -15.0 g; 95% CI -26.9, -3.0) and higher peri-conception HbA(1c) (b = -48.2 g; 95% CI -68.8, -27.6) were independently associated with birthweight reduction. Pre-pregnancy nephropathy (b = -282.7 g; 95% CI -461.8, -103.6) and retinopathy (b = -175.5 g; 95% CI -269.9, -81.0) were independent non-modifiable predictors of reduced birthweight, while greater maternal height was a non-modifiable predictor of increasing birthweight (b = 17.8 g; 95% CI 12.3, 23.2). Other predictors of birthweight increase were male sex, multiparity and increasing gestational age at delivery. Type or duration of diabetes, socioeconomic status and ethnicity were not associated with continuous birthweight.

Conclusions/interpretation: Poor glycaemic control before and throughout pregnancy is associated with abnormal fetal growth, with increasing peri-conception HbA(1c) predicting weight reduction and increasing third-trimester HbA(1c) predicting increased birthweight. Women with microvascular complications of diabetes may require increased surveillance to detect fetal growth restriction.

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References

Metzger B, Lowe L, Dyer A, Trimble E, Chaovarindr U, Coustan D . Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19):1991-2002. DOI: 10.1056/NEJMoa0707943. View

Richmond S, Atkins J . A population-based study of the prenatal diagnosis of congenital malformation over 16 years. BJOG. 2005; 112(10):1349-57. DOI: 10.1111/j.1471-0528.2005.00660.x. View

Macintosh M, Fleming K, Bailey J, Doyle P, Modder J, Acolet D . Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006; 333(7560):177. PMC: 1513435. DOI: 10.1136/bmj.38856.692986.AE. View

Bukowski R, Smith G, Malone F, Ball R, Nyberg D, Comstock C . Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study. BMJ. 2007; 334(7598):836. PMC: 1853211. DOI: 10.1136/bmj.39129.637917.AE. View

Lepercq J, Taupin P, Dubois-Laforgue D, Duranteau L, Lahlou N, Boitard C . Heterogeneity of fetal growth in type 1 diabetic pregnancy. Diabetes Metab. 2001; 27(3):339-44. View

Sojo L, Garcia-Patterson A, Maria M, Martin E, Ubeda J, Adelantado J . Are birth weight predictors in diabetic pregnancy the same in boys and girls?. Eur J Obstet Gynecol Reprod Biol. 2010; 153(1):32-7. DOI: 10.1016/j.ejogrb.2010.07.002. View

Weiss U, Cervar M, Puerstner P, Schmut O, Haas J, Mauschitz R . Hyperglycaemia in vitro alters the proliferation and mitochondrial activity of the choriocarcinoma cell lines BeWo, JAR and JEG-3 as models for human first-trimester trophoblast. Diabetologia. 2001; 44(2):209-19. DOI: 10.1007/s001250051601. View

Nielsen G, Dethlefsen C, Moller M, Sorensen H . 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(4):384-7. DOI: 10.1111/j.1464-5491.2007.02103.x. View

Weindling A . Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med. 2009; 14(2):111-8. DOI: 10.1016/j.siny.2008.11.007. View

10.

Yang J, Cummings E, OConnell C, Jangaard K . Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol. 2006; 108(3 Pt 1):644-50. DOI: 10.1097/01.AOG.0000231688.08263.47. View

11.

Reece E, Leguizamon G, Homko C . Pregnancy performance and outcomes associated with diabetic nephropathy. Am J Perinatol. 1998; 15(7):413-21. DOI: 10.1055/s-2007-993968. View

12.

Jensen D, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard J, Moeller M . Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care. 2004; 27(12):2819-23. DOI: 10.2337/diacare.27.12.2819. View

13.

Bell R, Bailey K, Cresswell T, Hawthorne G, Critchley J, Lewis-Barned N . Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG. 2008; 115(4):445-52. DOI: 10.1111/j.1471-0528.2007.01644.x. View

14.

Vambergue A, Fajardy I . Consequences of gestational and pregestational diabetes on placental function and birth weight. World J Diabetes. 2011; 2(11):196-203. PMC: 3215769. DOI: 10.4239/wjd.v2.i11.196. View

15.

Mello G, Parretti E, Mecacci F, LA TORRE P, Cioni R, Cianciulli D . What degree of maternal metabolic control in women with type 1 diabetes is associated with normal body size and proportions in full-term infants?. Diabetes Care. 2000; 23(10):1494-8. DOI: 10.2337/diacare.23.10.1494. View

16.

Evers I, de Valk H, H A Visser G . Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004; 328(7445):915. PMC: 390158. DOI: 10.1136/bmj.38043.583160.EE. View

17.

Johnson R, Schoeni R . Early-life origins of adult disease: national longitudinal population-based study of the United States. Am J Public Health. 2011; 101(12):2317-24. PMC: 3222421. DOI: 10.2105/AJPH.2011.300252. View

18.

Kerssen A, Evers I, de Valk H, Visser G . 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(5):309-13. DOI: 10.1080/jmf.13.5.309.313. View

19.

Bell R, Glinianaia S, Tennant P, Bilous R, Rankin J . Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia. 2012; . DOI: 10.1007/s00125-012-2455-y. View

20.

Rackham O, Paize F, Weindling A . Cause of death in infants of women with pregestational diabetes mellitus and the relationship with glycemic control. Postgrad Med. 2009; 121(4):26-32. DOI: 10.3810/pgm.2009.07.2026. View