Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA_1c and spikes of high glucose values in the third trimester

Abstract

Objective: To analyse data from a randomised, controlled study of prandial insulin aspart versus human insulin, both with NPH insulin, in pregnant women with type 1 diabetes for potential factors predicting poor pregnancy outcomes.

Research design/method: Post hoc analysis including 91 subjects randomised prior to pregnancy with known outcome in early pregnancy and 259 subjects randomised prior to pregnancy/during pregnancy of <10 weeks’ gestation with known late-pregnancy outcomes. Poor early-pregnancy outcomes included fetal loss <22 gestational weeks and/or congenital malformation (n = 18). Poor late-pregnancy outcomes included: composite endpoint including pre-eclampsia, preterm delivery and perinatal death (n = 78); preterm delivery (n = 63); and excessive fetal growth (n = 88).

Results: 18 patients experienced a malformed/lost fetus in early pregnancy – none preceded by severe hypoglycaemia. Albuminuria in early pregnancy was a significant predictor of poor late-pregnancy outcome (composite endpoint; p = 0.012). In the third trimester, elevated HbA_1c, ≥ 1 plasma glucose (PG) measurement >11 mmol/L (198 mg/dL) and %PG values outside 3.9–7.0 mmol/L (70–126 mg/dL) were significant predictors of poor late-pregnancy outcomes (all p < 0.05).

Conclusions: Elevated HbA_1c, high glucose spikes and out-of-range %PG in the third trimester, and albuminuria in early pregnancy, are associated with poor late-pregnancy outcomes.

• HbA_1c
• glucose spikes
• predictors
• pregnancy outcome

Acknowledgements

P. D. is the guarantor for this work and, as such, has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors thank Liz Southey, Watermeadow Medical, Witney, UK, for help with preparing this manuscript, funded by Novo Nordisk. The study on which this analysis is based was funded by Novo Nordisk.