Maternal third trimester hyperglycaemic excursions predict large-for-gestational-age infants in type 1 diabetic pregnancy

Abstract Objective To determine which maternal glycaemic parameters in type 1 diabetes better predict large-for-gestational-age (LGA) infants. Methods Maternal glycaemic parameters (mean overall, preprandial, and postprandial glucose; the percentage of glucose readings above and below target and HbA...

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Published in:Diabetes research and clinical practice 2007-01, Vol.75 (1), p.42-46
Main Authors: Herranz, Lucrecia, Pallardo, Luis F, Hillman, Natalia, Martin-Vaquero, Pilar, Villarroel, Africa, Fernandez, Alberto
Format: Article
Language:English
Subjects:
Birth Weight
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 1 - blood
Diabetes Mellitus, Type 1 - physiopathology
Endocrinology & Metabolism
Female
Gestational Age
Humans
Hyperglycaemic excursions
Hyperglycemia - blood
Hyperglycemia - physiopathology
Infant, Newborn
Large for gestational age
Pregnancy
Pregnancy Complications - blood
Pregnancy Complications - physiopathology
Pregnancy Trimester, Third
Type 1 diabetes
Ultrasonography, Prenatal
Weight Gain
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Summary:Abstract Objective To determine which maternal glycaemic parameters in type 1 diabetes better predict large-for-gestational-age (LGA) infants. Methods Maternal glycaemic parameters (mean overall, preprandial, and postprandial glucose; the percentage of glucose readings above and below target and HbA1c levels) of LGA ( n = 37) and appropriate-for-gestational-age ( n = 36) infants were compared during preconception and each trimester of pregnancy. Logistic regression was used to select predictive variables. Results Preconception glycaemic parameters were not different. Mean glucose and the percentage of glucose readings above target were higher in mothers of LGA infants in every trimester of pregnancy. Second and third trimesters mean postprandial glucose, third trimester mean preprandial glucose and third trimester HbA1c were also higher. Only third trimester glycaemic variables were risk indicators of LGA infants: mean glucose (OR: 3.45; 95% CI: 1.52–7.80), mean preprandial glucose (OR: 2.97; 95% CI: 1.34–6.60), mean postprandial glucose (OR: 2.09; 95% CI: 1.19–3.67) and the percentage of glucose readings above target (OR: 1.08; 95% CI: 1.03–1.14). The percentage of glucose readings above target was the best risk indicator. Conclusions Third trimester glycaemic parameters are more powerful predictors of foetal growth than glycaemic parameters earlier in pregnancy or during preconception. Hyperglycaemic excursions are the strongest predictor of LGA infants.
ISSN:0168-8227
1872-8227
DOI:10.1016/j.diabres.2006.05.019