Large-for-gestational-age (LGA) neonate predicts a 2.5-fold increased odds of neonatal hypoglycaemia in women with type 1 diabetes

Abstract Background Offspring of women with type 1 diabetes are at increased risk of accelerated fetal growth which is associated with perinatal morbidity. Growth standards are used to identify large- or small- for gestational age (LGA, SGA) infants. Our aim was to examine which growth standards identify infants at risk of perinatal complications during the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles calculated. Unadjusted logistic regression identified the associations between different growth standards and perinatal outcomes including preterm delivery, Caesarean delivery, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. All standards were associated with some but not all perinatal outcomes studied. Infants born >97.7 th centile were at highest risk of complications. Conclusions WHO standards underestimated birthweight centile. GROW and INTERGROWTH standards identified similar numbers of infants as LGA and SGA with GROW showing stronger associations with neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants with suspected birthweight >97.7th centile according to any standard may require extra surveillance. Definitions of LGA and SGA should be re-evaluated in diabetic pregnancy.

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

10.21203/rs.3.rs-27918/v3 ◽

2020 ◽

Author(s):

Claire L Meek ◽

Rosa Corcoy ◽

Elizabeth Asztalos ◽

Laura Caroline Kusinski ◽

Esther Lopez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Neonatal Hypoglycaemia ◽

Growth Standards ◽

Who Standards ◽

Nicu Admission

Abstract Background Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born >97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes. Conclusions GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.Trial registration: This trial is registered with ClinicalTrials.gov. number NCT01788527.

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Gestational glycemia in association with delivery with a large for gestational age baby in women with type 1 diabetes

10.26226/morressier.5d9b6233ea541d6ca8494363 ◽

2019 ◽

Author(s):

Inashvili Ekaterine

Keyword(s):

Type 1 Diabetes ◽

Gestational Age ◽

Large For Gestational Age

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Glycemic Excursions in Type 1 Diabetes in Pregnancy: A Semiparametric Statistical Approach to Identify Sensitive Time Points during Gestation

Journal of Diabetes Research ◽

10.1155/2017/2852913 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Resmi Gupta ◽

Jane Khoury ◽

Mekibib Altaye ◽

Lawrence Dolan ◽

Rhonda D. Szczesniak

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Gestational Age ◽

Glucose Monitoring ◽

Large For Gestational Age ◽

Optimal Timing ◽

Care Providers ◽

Delivery Outcome ◽

Glucose Levels

Aim.To examine the gestational glycemic profile and identify specific times during pregnancy that variability in glucose levels, measured by change in velocity and acceleration/deceleration of blood glucose fluctuations, is associated with delivery of a large-for-gestational-age (LGA) baby, in women with type 1 diabetes.Methods.Retrospective analysis of capillary blood glucose levels measured multiple times daily throughout gestation in women with type 1 diabetes was performed using semiparametric mixed models.Results.Velocity and acceleration/deceleration in glucose levels varied across gestation regardless of delivery outcome. Compared to women delivering LGA babies, those delivering babies appropriate for gestational age exhibited significantly smaller rates of change and less variation in glucose levels between 180 days of gestation and birth.Conclusions.Use of innovative statistical methods enabled detection of gestational intervals in which blood glucose fluctuation parameters might influence the likelihood of delivering LGA baby in mothers with type 1 diabetes. Understanding dynamics and being able to visualize gestational changes in blood glucose are a potentially useful tool to assist care providers in determining the optimal timing to initiate continuous glucose monitoring.

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