Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial
Por:
Yamamoto, JM, Corcoy, R, Donovan, LE, Stewart, ZA, Tomlinson, G, Beardsall, K, Feig, DS, Murphy, HR, CONCEPTT Collaborative Grp
Publicada:
1 ago 2019
Resumen:
Aims To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants. Methods A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose. Results Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA(1c) [48 +/- 7 (6.6 +/- 0.6) vs. 45 +/- 7 (6.2 +/- 0.6); P = 0.0009 and 50 +/- 7 (6.7 +/- 0.6) vs. 46 +/- 7 (6.3 +/- 0.6); P = 0.0001] and lower continuous glucose monitoring time-in-range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C-peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P <= 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia. Conclusions Modest increments in continuous glucose monitoring time-in-target (5-7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period.
Filiaciones:
Yamamoto, JM:
Univ Calgary, Dept Med, Calgary, AB, Canada
Univ Calgary, Dept Obstet & Gynaecol, Calgary, AB, Canada
Alberta Childrens Hosp Res Inst, Calgary, AB, Canada
Corcoy, R:
Hosp Santa Creu & Sant Pau, Serv Endocrinol & Nutr, Barcelona, Spain
CIBER BBN, Madrid, Spain
Donovan, LE:
Univ Calgary, Dept Med, Calgary, AB, Canada
Univ Calgary, Dept Obstet & Gynaecol, Calgary, AB, Canada
Alberta Childrens Hosp Res Inst, Calgary, AB, Canada
Stewart, ZA:
Univ Cambridge, Wellcome Trust Med Res Council Inst Metab Sci, Cambridge, England
Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
Tomlinson, G:
Univ Hlth Network, Dept Med, Toronto, ON, Canada
Beardsall, K:
Univ Cambridge, Dept Paediat, Cambridge, England
Cambridge Univ Hosp NHS Fdn Trust, Neonatal Unit, Cambridge, England
Feig, DS:
Univ Toronto, Dept Med, Toronto, ON, Canada
Sinai Hlth Syst, Mt Sinai Hosp, Toronto, ON, Canada
Lunenfeld Tanenbaum Res Inst, Toronto, ON, Canada
Murphy, HR:
Univ Cambridge, Wellcome Trust Med Res Council Inst Metab Sci, Cambridge, England
Kings Coll London, Womens Hlth Acad Ctr, Div Womens & Childrens Hlth, London, England
Univ East Anglia, Norwich Med Sch, Floor 2,Bob Champ Res & Educ Bldg,James Watson Rd, Norwich, Norfolk, England
Green Accepted
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