engleski

Large-For-Gestational-Age Neonates in Diabetes Mellitus Type 1 Pregnancy Treated With Continuous Subcutaneous Insulin Infusion: The Impact of Last Trimester A1C

We retrospectively analyzed data of 16 pregnant women diagnosed with T1DM for at least for more than 2 years before pregnancy and treated with CSII (Medtronic MiniMed™ Paradigm™ Veo™) for at least 3 months prior to conception. At the time of conception the median age was 28.5 years (23-36), median body mass index (BMI) 23.1 kg/m2 (19-33) and median A1C 6.5 % (4.8-8.8). In the last trimester, the A1C was significantly lower (p= 0.01), with a median of 5.5 % (4.6-7.1) and the median weight gain during pregnancy was 13 kg (4- 20). All patients successfully delivered by caesarean section (standard practice for women with T1DM in the facility) without significant peripartum complications. The median week of delivery was 38 (35–39) and the median APGAR score was 10 (9–10). When corrected for gender and gestational age, 31% of newborns were LGA, there was one preterm birth. Macrosomia was present in 19% of neonates. Among several analyzed parameters at the time of conception (BMI, body weight, total, basal and prandial insulin dose, A1C) and same parameters in the last trimester including weight gain during pregnancy, only last trimester A1C was significant as a neonatal birth weight predictor. It had a strong positive correlation to neonatal birth weight (p=0.002, r=0.712) and in linear regression analysis its influence on birth weight was 65.3% (R square = 0.653 and ANOVA significance p=0.000). Despite high uptake levels of advanced diabetes technologies among pregnant women, rates of adverse fetal outcomes remain far above the target. Having in mind huge influence of last trimester A1C on birth weight we found in cohort of T1DM patients treated with CSII, an extra effort should be made to persist with strict glyceamic control throughout the pregnancy and avoid LGA of neonates.

type 1 diabetes mellitus ; pregnancy ; large-for-gestational-age neonates

Epub 2020 Apr 7