Maternal glucose variability during pregnancy & birthweight percentile in women with pre-gestational diabetes

Abstract

Introduction

Pre-gestational diabetes mellitus (PGDM) is a major risk factor for fetal overgrowth. Interestingly, even in relatively well controlled PGDM women, as determined by average glucose indices such HbA1c, there is an increased rate of LGA (large for gestational age). Glucose variability (GV) has emerged as an important independent risk factor for several diabetes complications. The aim of this study was to determine the relationship between maternal GV indices and neonatal birth percentile.

Methods

This was a historical cohort study that included all consecutive PGDM women monitored in a single tertiary care center. Clinical and demographic variables, as well as data regarding glucose control, were prospectively recorded. Mean, standard deviation (SD) and coefficient of variance (CV) of glucose values were calculated. Pearson correlations coefficient was used to determine the correlation between glucose indices and birth percentile. The analysis was repeated after adjustment for several confounders.

Results

Mean birthweight and birthweight percentile were 3212 ± 532 g and 66.9%, respectively. There was a statistically significant correlation between birthweight percentile and maternal glucose SD (β = 0.28, p = .002) and maternal glucose CV (β = 0.21, p = .019). There was no significant correlation between birthweight percentile and mean glucose values. The association between the maternal glucose SD and birthweight percentile remained statistically significant after adjustment for maternal age, pre-pregnancy BMI and duration of diabetes.

Conclusion

There is an association between maternal glucose variability indices (SD and CV) during pregnancy and neonatal birth percentile. Larger studies are needed to confirm these results.

孕前糖尿病的孕妇妊娠期血糖变异性与新生儿出生体重百分位数 摘要

介绍：孕前糖尿病（pre-gestational diabetes mellitus, PGDM）是胎儿过度生长的主要危险因素。有趣的是, 即使在HbA1c等指数控制相对良好的PGDM孕妇中, 大于胎龄儿（large for gestational age, LGA）的发生率也有所增加。血糖变异性（glucose variability, GV）已成为几种糖尿病并发症的重要独立危险因素。本研究的目的是确定孕妇GV指数与新生儿出生体重百分位数之间的关系。

方法：这是一项回顾性队列研究, 纳入在一个三级护理中心持续监测的所有PGDM孕妇。记录临床和人口统计学变量以及有关血糖控制的数据。计算血糖值的平均值、标准差（SD）和变异系数（CV）。皮尔逊相关系数用于确定血糖指数与出生体重百分位数之间的相关性。在对几个混杂因素进行调整后, 再次分析。

结果：平均出生体重为3212 ± 532g, 出生体重百分位数为66.9%。出生体重百分位数与孕妇血糖SD（β=0.28, p=0.002）和孕妇血糖CV（β=0.21, p=0.019）之间有显著相关性。出生体重百分位数和平均血糖值之间没有显著相关性。调整母亲年龄、孕前BMI和糖尿病持续时间后, 孕妇血糖SD和出生体重百分位数仍有显著相关性。

结论：孕期母体血糖变异指数（SD和CV）与新生儿出生体重百分位数之间存在相关性。需要更大规模的研究来证实这些结果。

Keywords:

• Glucose variability
• pre-gestational diabetes
• LGA
• birth-percentile
• type 1 diabetes
• CGM
• insulin pump

Acknowledgment

The authors had no financial support of the study, no funding received for this work.

Ethical approval

The study was approved by the Sheba Institute IRB committee. Approval number 3004-16-SMC was given at February 7, 2016.

Author contributions

Nimrod Dori-Dayan: Involvement in conception and design of the project. Important contribution to critical aspects of the conduct of the research. Drafting the article submitted and revising it for important intellectual content

Rakefet Yoeli-Ullman: Involvement in conception and design of the project. Important contribution to critical aspects of the conduct of the research. Revising the article submitted for important intellectual content.

Tali Cukierman-Yaffe: Involvement in conception and design of the project. Important contribution to critical aspects of the conduct of the research. Revising the article submitted for important intellectual content.

Roni Zemet: Revising the article submitted for important intellectual content

Shali Mazaki-Tovi: Involvement in conception and design of the project. Important contribution to critical aspects of the conduct of the research. Revising the article submitted for important intellectual content.

Neomi Kedar: Important contribution to critical aspects of the conduct of the research.

Ohad Cohen: Involvement in conception and design of the project. Important contribution to critical aspects of the conduct of the research. Revising the article submitted for important intellectual content

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.