Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial
Por:
Meek, CL, Corcoy, R, Asztalos, E, Kusinski, LC, Lopez, E, Feig, DS, Murphy, HR, CONCEPTT Collaborative Grp
Publicada:
29 ene 2021
Resumen:
Background: Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).
Methods: This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres ( NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome.
Results: Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62, 67 and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2, 1.3 and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born > 97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes.
Conclusions: GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.
Trial registration: This trial is registered with ClinicalTrials.gov. number NCT01788527. Trial registered 11/2/2013.
Filiaciones:
Meek, CL:
Univ Cambridge, Inst Metab Sci, Addenbrookes Hosp, Box 289, Cambridge CB2 0QQ, England
Cambridge Univ NHS Fdn Trust, Cambridge, England
Corcoy, R:
Hosp Santa Creu & Sant Pau, Serv Endocrinol & Nutr, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, CIBER BBN, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Asztalos, E:
Univ Toronto, Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada
Kusinski, LC:
Univ Cambridge, Inst Metab Sci, Addenbrookes Hosp, Box 289, Cambridge CB2 0QQ, England
Cambridge Univ NHS Fdn Trust, Cambridge, England
Lopez, E:
Hosp Santa Creu & Sant Pau, Inst Recerca, CIBER BBN, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Serv Pediat, Barcelona, Spain
Feig, DS:
Univ Toronto, Mt Sinai Hosp, Dept Med, Toronto, ON, Canada
Lunenfeld Tanenbaum Res Inst, Toronto, ON, Canada
Murphy, HR:
Cambridge Univ NHS Fdn Trust, Cambridge, England
Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England
Kings Coll London, Dept Women & Childrens Hlth, London, England
Green Published, Green Submitted, gold, Green Accepted
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