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Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes.
BMC Pregnancy Childbirth. 2016 07 15; 16(1):162.BP

Abstract

BACKGROUND

The rate of neonatal overweight remains generally high in type 1 diabetes (T1DM). Since glycemic control has improved over time other contributors need to be identified. Our aim is to evaluate the risk factors for large-for-gestational age infants (LGA) in women with T1DM and to evaluate whether the rate of LGA decreased over time.

METHODS

Retrospective analysis of the medical files of pregnant women with T1DM attending our university hospital form 01-01-1992 till 31-07-2014. The generalized mixed model was used to adjust for several pregnancies over time in the same women. A multivariable model was used to evaluate independent risk factors for LGA.

RESULTS

Over a 22-year period, 259 pregnancies in 180 T1DM women were identified. Mean diabetes duration of women was 13.7 ± 7.1 years, with a mean age of 29.5 ± 5.2 years. Macrosomia (>4Kg) was present in 16.2 % of deliveries, LGA was present in 45.2 % and these numbers did not change over time (resp. p = 0.19 and p = 0.70). Over time, significant more women were overweight (23.3 % vs. 39.3 %, p = 0.009) and more women had excessive weight gain during pregnancy (21.3 % vs. 37.7 %, p = 0.019). Compared to women with a non-LGA baby, women with a LGA baby had a higher weight at delivery (84.1 ± 11.1 vs. 80.4 ± 10.8, p = 0.016), had more often excessive weight gain (45.3 % vs. 25.2 %, p = 0.003) and had less strict glycaemic control in the first and third trimester [HbA1c of resp. 49 ± 10 mmol/mol (6.7 % ±0.9) vs. 47 ± 8 mmol/mol (6.5 % ±0.8), p = 0.01 and 44 ± 5 mmol/mol (6.2 % ±0.5) vs. 42 ± 6 mmol/mol (6.0 % ±0.6), p = 0.01]. In the forward multivariable analysis, excessive weight gain [OR 1.95 (1.08-3.53), p = 0.027], HbA1c level in early [OR 1.43 (1.05-1.95), p = 0.023] and late pregnancy [OR 1.70 (1.07-2.71), p = 0.026] remained independent predictors for LGA.

CONCLUSIONS

LGA remains a frequent complication in T1DM. Excessive weight gain and HbA1c in early and late pregnancy are important risk factors for LGA in our population. These findings highlight the importance of strict maternal glycemic control and simultaneous striving to appropriate gestational weight gain to minimize the risk of fetal overgrowth in T1DM pregnancies.

Authors+Show Affiliations

Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.Department of Pediatrics, UZ Gasthuisberg, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, Leuven, 3000, Belgium. katrien.benhalima@uzleuven.be.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27421257

Citation

Morrens, Astrid, et al. "Risk Factors for Large-for-gestational Age Infants in Pregnant Women With Type 1 Diabetes." BMC Pregnancy and Childbirth, vol. 16, no. 1, 2016, p. 162.
Morrens A, Verhaeghe J, Vanhole C, et al. Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes. BMC Pregnancy Childbirth. 2016;16(1):162.
Morrens, A., Verhaeghe, J., Vanhole, C., Devlieger, R., Mathieu, C., & Benhalima, K. (2016). Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes. BMC Pregnancy and Childbirth, 16(1), 162. https://doi.org/10.1186/s12884-016-0958-0
Morrens A, et al. Risk Factors for Large-for-gestational Age Infants in Pregnant Women With Type 1 Diabetes. BMC Pregnancy Childbirth. 2016 07 15;16(1):162. PubMed PMID: 27421257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes. AU - Morrens,Astrid, AU - Verhaeghe,Johan, AU - Vanhole,Christine, AU - Devlieger,Roland, AU - Mathieu,Chantal, AU - Benhalima,Katrien, Y1 - 2016/07/15/ PY - 2015/12/12/received PY - 2016/07/09/accepted PY - 2016/7/17/entrez PY - 2016/7/17/pubmed PY - 2017/12/2/medline KW - Large-for-gestational age infants KW - Pregnancy KW - Type 1 diabetes KW - Weight gain SP - 162 EP - 162 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 16 IS - 1 N2 - BACKGROUND: The rate of neonatal overweight remains generally high in type 1 diabetes (T1DM). Since glycemic control has improved over time other contributors need to be identified. Our aim is to evaluate the risk factors for large-for-gestational age infants (LGA) in women with T1DM and to evaluate whether the rate of LGA decreased over time. METHODS: Retrospective analysis of the medical files of pregnant women with T1DM attending our university hospital form 01-01-1992 till 31-07-2014. The generalized mixed model was used to adjust for several pregnancies over time in the same women. A multivariable model was used to evaluate independent risk factors for LGA. RESULTS: Over a 22-year period, 259 pregnancies in 180 T1DM women were identified. Mean diabetes duration of women was 13.7 ± 7.1 years, with a mean age of 29.5 ± 5.2 years. Macrosomia (>4Kg) was present in 16.2 % of deliveries, LGA was present in 45.2 % and these numbers did not change over time (resp. p = 0.19 and p = 0.70). Over time, significant more women were overweight (23.3 % vs. 39.3 %, p = 0.009) and more women had excessive weight gain during pregnancy (21.3 % vs. 37.7 %, p = 0.019). Compared to women with a non-LGA baby, women with a LGA baby had a higher weight at delivery (84.1 ± 11.1 vs. 80.4 ± 10.8, p = 0.016), had more often excessive weight gain (45.3 % vs. 25.2 %, p = 0.003) and had less strict glycaemic control in the first and third trimester [HbA1c of resp. 49 ± 10 mmol/mol (6.7 % ±0.9) vs. 47 ± 8 mmol/mol (6.5 % ±0.8), p = 0.01 and 44 ± 5 mmol/mol (6.2 % ±0.5) vs. 42 ± 6 mmol/mol (6.0 % ±0.6), p = 0.01]. In the forward multivariable analysis, excessive weight gain [OR 1.95 (1.08-3.53), p = 0.027], HbA1c level in early [OR 1.43 (1.05-1.95), p = 0.023] and late pregnancy [OR 1.70 (1.07-2.71), p = 0.026] remained independent predictors for LGA. CONCLUSIONS: LGA remains a frequent complication in T1DM. Excessive weight gain and HbA1c in early and late pregnancy are important risk factors for LGA in our population. These findings highlight the importance of strict maternal glycemic control and simultaneous striving to appropriate gestational weight gain to minimize the risk of fetal overgrowth in T1DM pregnancies. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/27421257/Risk_factors_for_large_for_gestational_age_infants_in_pregnant_women_with_type_1_diabetes_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0958-0 DB - PRIME DP - Unbound Medicine ER -