Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Aims/hypothesis

The aim of this study was to analyse patterns of continuous glucose monitoring (CGM) data for associations with large for gestational age (LGA) infants and an adverse neonatal composite outcome (NCO) in pregnancies in women with type 1 diabetes.

Methods

This was an observational cohort study of 186 pregnant women with type 1 diabetes in Sweden. The interstitial glucose readings from 92 real-time (rt) CGM and 94 intermittently viewed (i) CGM devices were used to calculate mean glucose, SD, CV%, time spent in target range (3.5–7.8 mmol/l), mean amplitude of glucose excursions and also high and low blood glucose indices (HBGI and LBGI, respectively). Electronic records provided information on maternal demographics and neonatal outcomes. Associations between CGM indices and neonatal outcomes were analysed by stepwise logistic regression analysis adjusted for confounders.

Results

The number of infants born LGA was similar in rtCGM and iCGM users (52% vs 53%). In the combined group, elevated mean glucose levels in the second and the third trimester were significantly associated with LGA (OR 1.53, 95% CI 1.12, 2.08, and OR 1.57, 95% CI 1.12, 2.19, respectively). Furthermore, a high percentage of time in target in the second and the third trimester was associated with lower risk of LGA (OR 0.96, 95% CI 0.94, 0.99 and OR 0.97, 95% CI 0.95, 1.00, respectively). The same associations were found for mean glucose and for time in target and the risk of NCO in all trimesters. SD was significantly associated with LGA in the second trimester and with NCO in the third trimester. Glucose patterns did not differ between rtCGM and iCGM users except that rtCGM users had lower LBGI and spent less time below target.

Conclusions/interpretation

Higher mean glucose levels, higher SD and less time in target range were associated with increased risk of LGA and NCO. Despite the use of CGM throughout pregnancy, the day-to-day glucose control was not optimal and the incidence of LGA remained high.

Electronic supplementary material

The online version of this article (10.1007/s00125-019-4850-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Related collections

Most cited references 35

Record: found
Abstract: found
Article: not found

High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia.

Tine D Clausen, Elisabeth R Mathiesen, Torben Hansen … (2008)

The role of intrauterine hyperglycemia and future risk of type 2 diabetes in human offspring is debated. We studied glucose tolerance in adult offspring of women with either gestational diabetes mellitus (GDM) or type 1 diabetes, taking the impact of both intrauterine hyperglycemia and genetic predisposition to type 2 diabetes into account. The glucose tolerance status following a 2-h 75-g oral glucose tolerance test (OGTT) was evaluated in 597 subjects, primarily Caucasians, aged 18-27 years. They were subdivided into four groups according to maternal glucose metabolism during pregnancy and genetic predisposition to type 2 diabetes: 1) offspring of women with diet-treated GDM (O-GDM), 2) offspring of genetically predisposed women with a normal OGTT (O-NoGDM), 3) offspring of women with type 1 diabetes (O-type 1), and 4) offspring of women from the background population (O-BP). The prevalence of type 2 diabetes and pre-diabetes (impaired glucose tolerance or impaired fasting glucose) in the four groups was 21, 12, 11, and 4%, respectively. In multiple logistic regression analysis, the adjusted odds ratios (ORs) for type 2 diabetes/pre-diabetes were 7.76 (95% CI 2.58-23.39) in O-GDM and 4.02 (1.31-12.33) in O-type 1 compared with O-BP. In O-type 1, the risk of type 2 diabetes/pre-diabetes was significantly associated with elevated maternal blood glucose in late pregnancy: OR 1.41 (1.04-1.91) per mmol/l. A hyperglycemic intrauterine environment appears to be involved in the pathogenesis of type 2 diabetes/pre-diabetes in adult offspring of primarily Caucasian women with either diet-treated GDM or type 1 diabetes during pregnancy.

0 comments Cited 267 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia.

Teresa A. Hillier, Kathryn L Pedula, Mark Schmidt … (2007)

The purpose of this study was to determine how the range of measured maternal glycemia in pregnancy relates to risk of obesity in childhood. Universal gestational diabetes mellitus (GDM) screening (a 50-g glucose challenge test [GCT]) was performed in two regions (Northwest and Hawaii) of a large diverse HMO during 1995-2000, and GDM was diagnosed/treated using a 3-h 100-g oral glucose tolerance test (OGTT) and National Diabetes Data Group (NDDG) criteria. Measured weight in offspring (n = 9,439) was ascertained 5-7 years later to calculate sex-specific weight-for-age percentiles using U.S. norms (1963-1994 standard) and then classified by maternal positive GCT (1 h >or= 7.8 mmol/l) and OGTT results (1 or >or=2 of the 4 time points abnormal: fasting, 1 h, 2 h, or 3 h by Carpenter and Coustan and NDDG criteria). There was a positive trend for increasing childhood obesity at age 5-7 years (P < 0.0001; 85th and 95th percentiles) across the range of increasing maternal glucose screen values, which remained after adjustment for potential confounders including maternal weight gain, maternal age, parity, ethnicity, and birth weight. The risk of childhood obesity in offspring of mothers with GDM by NDDG criteria (treated) was attenuated compared with the risks for the groups with lesser degrees of hyperglycemia (untreated). The relationships were similar among Caucasians and non-Caucasians. Stratification by birth weight also revealed these effects in children of normal birth weight (

0 comments Cited 212 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics.

Cande V. Ananth, Enrique Schisterman (2017)

Prospective and retrospective cohorts and case-control studies are some of the most important study designs in epidemiology because, under certain assumptions, they can mimic a randomized trial when done well. These assumptions include, but are not limited to, properly accounting for 2 important sources of bias: confounding and selection bias. While not adjusting the causal association for an intermediate variable will yield an unbiased estimate of the exposure-outcome's total causal effect, it is often that obstetricians will want to adjust for an intermediate variable to assess if the intermediate is the underlying driver of the association. Such a practice must be weighed in light of the underlying research question and whether such an adjustment is necessary should be carefully considered. Gestational age is, by far, the most commonly encountered variable in obstetrics that is often mislabeled as a confounder when, in fact, it may be an intermediate. If, indeed, gestational age is an intermediate but if mistakenly labeled as a confounding variable and consequently adjusted in an analysis, the conclusions can be unexpected. The implications of this overadjustment of an intermediate as though it were a confounder can render an otherwise persuasive study downright meaningless. This commentary provides an exposition of confounding bias, collider stratification, and selection biases, with applications in obstetrics and perinatal epidemiology.

0 comments Cited 115 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Karl Kristensen:

ORCID: http://orcid.org/0000-0003-3209-2459

karl.kristensen@med.lu.se

Journal

Journal ID (nlm-ta): Diabetologia

Journal ID (iso-abbrev): Diabetologia

Title: Diabetologia

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0012-186X

ISSN (Electronic): 1432-0428

Publication date (Electronic): 23 March 2019

Publication date PMC-release: 23 March 2019

Publication date (Print): 2019

Volume: 62

Issue: 7

Pages: 1143-1153

Affiliations

[1 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Department of Clinical Sciences Lund, , Lund University, ; Sölvegatan 19, 221 84 Lund, Sweden

[2 ]ISNI 0000 0004 0646 7373, GRID grid.4973.9, The Parker Institute, , Copenhagen University Hospital, ; Copenhagen, Denmark

[3 ]ISNI 0000 0004 0623 9987, GRID grid.411843.b, Department of Obstetrics and Gynecology, , Skåne University Hospital, ; Malmö, Sweden

[4 ]ISNI 000000009445082X, GRID grid.1649.a, Department of Obstetrics and Gynecology, , Sahlgrenska University Hospital, ; Gothenburg, Sweden

[5 ]ISNI 0000 0000 9919 9582, GRID grid.8761.8, Sahlgrenska Academy, , University of Gothenburg, ; Gothenburg, Sweden

[6 ]ISNI 000000009445082X, GRID grid.1649.a, Department of Medicine, , Östra/Sahlgrenska University Hospital, ; Gothenburg, Sweden

[7 ]ISNI 000000009445082X, GRID grid.1649.a, Department of Pediatrics, , Sahlgrenska University Hospital, ; Gothenburg, Sweden

[8 ]ISNI 0000 0004 0646 7402, GRID grid.411646.0, Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, , Gentofte Hospital, ; Hellerup, Denmark

[9 ]ISNI 0000 0001 0674 042X, GRID grid.5254.6, Department of Clinical Medicine, Faculty of Health and Medical Sciences, , University of Copenhagen, ; Copenhagen, Denmark

[10 ]ISNI 0000 0004 0623 9987, GRID grid.411843.b, Department of Endocrinology, , Skåne University Hospital, ; Malmö, Sweden

[11 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Department of Clinical Sciences Malmö, , Lund University, ; Lund, Sweden

Author information

Karl Kristensen http://orcid.org/0000-0003-3209-2459

Article

Publisher ID: 4850

DOI: 10.1007/s00125-019-4850-0

PMC ID: 6560021

PubMed ID: 30904938

SO-VID: b97ab7cc-3dc1-44c2-a073-44ba78d4555c

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 16 December 2018

Date accepted : 25 February 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100001275, Oak Foundation;

Funded by: Region Skåne Research Grant

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: continuous glucose monitoring,fetal growth,neonatal complications,pregnancy,type 1 diabetes

Data availability: