Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes
Por:
Bahrami, J, Tomlinson, G, Murphy, HR, Feig, DS, Corcoy R., CHICO BALLESTEROS, ANA ISABEL, CONCEPTT Collaborative Grp
Publicada:
1 may 2022
Ahead of Print:
1 ene 2022
Resumen:
Aims To examine maternal fear of hypoglycaemia, glycaemia and pregnancy outcomes in women with impaired and normal awareness of hypoglycaemia. Methods A pre-planned sub-study of 214 pregnant women with type 1 diabetes who participated in the CONCEPTT trial. Participants completed hypoglycaemia fear surveys (HFS-II) at baseline. Logistic regression and Poisson regression analyses were used to obtain an adjusted estimate for the rate ratio relating awareness to the number of severe hypoglycaemic episodes, and for several neonatal outcomes in relation to the total HFS-II score. The role of continuous glucose monitoring (CGM) use was examined. Results Overall, 30% of participants reported impaired awareness of hypoglycaemia (n = 64). Women with impaired awareness of hypoglycaemia had more episodes of severe hypoglycaemia (mean 0.44 vs. 0.08, p < 0.001) (12-34 weeks gestation) and scored higher on the HFS-II scale (43.7 vs. 36.0, p 0.008), indicating more fear of hypoglycaemia. They spent more time below range (CGM <3.5 mmol/L) and exhibited more glycaemic variability at 12 weeks gestation. Higher overall HFS-II scores were associated with a higher risk of maternal severe hypoglycaemia episodes (Rate Ratio 1.78, 95% CI 1.39-2.27). Women with impaired awareness of hypoglycaemia had less maternal weight gain but there were no differences in neonatal outcomes between women with impaired awareness of hypoglycaemia and normal hypoglycaemia awareness. Higher HFS-II scores were associated with more nephropathy (Odds Ratio 1.91, 95% CI 1.06-3.4). CGM use after 12 weeks was not associated with the number of episodes of severe hypoglycaemia (RR 0.75, 95% CI 0.49-1.15; p = 0.18). Conclusions In pregnant women with type 1 diabetes, impaired awareness of hypoglycaemia is associated with more maternal severe hypoglycaemia episodes and more fear of hypoglycaemia. Having impaired awareness of hypoglycaemia and/or fear of hypoglycaemia should alert clinicians to this increased risk. Reassuringly, there was no increase in adverse neonatal outcomes.
Filiaciones:
Bahrami, J:
Univ Toronto, Dept Med, Toronto, ON, Canada
Mt Sinai Hosp, Leadership Sinai Ctr Diabet, Sinai Hlth Syst, Toronto, ON, Canada
Markham Stouffville Hosp, Markham, ON, Canada
Tomlinson, G:
Univ Toronto, Dept Med, Toronto, ON, Canada
Univ Hlth Network, Toronto, ON, Canada
Murphy, HR:
Cambridge Univ Hosp NHS Fdn Trust, Cambridge, England
Univ East Anglia, Fac Med & Hlth Sci, Norwich Med Sch, Norwich, Norfolk, England
Feig, DS:
Univ Toronto, Dept Med, Toronto, ON, Canada
Mt Sinai Hosp, Leadership Sinai Ctr Diabet, Sinai Hlth Syst, Toronto, ON, Canada
Lunenfeld Tanenbaum Res Inst, Toronto, ON, Canada
Corcoy R.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
CHICO BALLESTEROS, ANA ISABEL:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Green Accepted, Green Published
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