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Continuous Glucose Monitoring, Glycemic Variability, and Excessive Fetal Growth in Pregnancies Complicated by Type 1 Diabetes.

Abstract：

BACKGROUND:To examine trimester-specific associations among glycemic variability, fetal growth, and birthweight in pregnancies with type 1 diabetes mellitus (Type 1 DM). METHODS:In this retrospective cohort study of 41 pregnant women with Type 1 DM, we used continuous glucose monitoring (CGM) data to calculate glycemic variability (coefficient of variation of glucose) over a 7-day interval in each trimester. Clinical data, including fetal biometry, birthweight, and perinatal complications, were extracted from medical records. RESULTS:Women maintained good glycemic control during pregnancy, with mean HbA1c in the first, second, and third trimester 6.5%, 6.1%, and 6.4%, respectively. Sixty-three percent of infants were large for gestational age (LGA). Estimated fetal weight percentile (EFW%ile) and abdominal circumference percentile (AC%ile) increased during pregnancy, consistent with accelerated prenatal growth. Correlations between trimester-specific glycemic variability and EFW, AC, and birthweight were not statistically significant. After maternal age adjustment, glycemic variability was not associated with birthweight for any trimester (adj. β for first trimester: -38.46, 95% CI: -98.58 to 21.66; adj. β for second trimester: -12.20, 95% CI: -51.47 to 27.06; adj. β for third trimester: -26.26, 95% CI: -79.52 to 27.00). CONCLUSIONS:The occurrence of LGA remains very high in contemporary U.S. women with Type 1 DM, despite the use of CGM and overall good glycemic control. Neither HbA1c nor glycemic variability predicted fetal overgrowth or birthweight. Since LGA is a key driver of maternal and newborn complications in pregnancies with Type 1 DM, our data emphasize the importance of investigating both glucose-dependent and glucose-independent underlying mechanisms.

journal_name

Diabetes Technol Ther

journal_title

Diabetes technology & therapeutics

authors

Mulla BM,Noor N,James-Todd T,Isganaitis E,Takoudes TC,Curran A,Warren CE,O'Brien KE,Brown FM

doi

10.1089/dia.2017.0443

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

413-419

issue

eissn

1520-9156

issn

1557-8593

journal_volume

pub_type

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Continuous Glucose Monitoring, Glycemic Variability, and Excessive Fetal Growth in Pregnancies Complicated by Type 1 Diabetes.