Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands

被引:214
作者
Evers, IM
de Valk, HW
Mol, BWJ
ter Braak, EWMT
Visser, GHA
机构
[1] Univ Utrecht, Med Ctr, Dept Obstet, NL-3508 AB Utrecht, Netherlands
[2] Univ Utrecht, Med Ctr, Dept Internal Med & Endocrinol, NL-3508 AB Utrecht, Netherlands
关键词
macrosomia; glycaemic control; diabetes mellitus; Type I diabetes; pregnancy;
D O I
10.1007/s00125-002-0958-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims/hypothesis. To investigate the incidence of foetal macrosomia (i.e. birth weight >90th percentile) in a non selected nationwide cohort of women with Type I (insulin-dependent) diabetes mellitus an The Netherlands and to identify risk indicators predictive for macrosomia. Methods: We conducted a prospective nationwide cohort based survey regarding the outcome of Type I diabetic pregnancy in The Netherlands. Data of 289 women who gave birth to a live singleton infant without major congenital malformations at more than or equal to 28 weeks of gestation are shown. Results The incidence of foetal macrosomia vas very high (48.8%), with 26.6% of infants weighing more than 97.7th percentile. Glycaemic control during pregnancy vas good (i.e. mean HbA(1c) less than or equal to7.0%), in almost all (84%) women. Multiple logistic regression analysis resulted in a predictive model for macrosomia that incorporated five variables: third trimester HbA(1c) (Odds Ratio [95% Confidence Interval]: (1.6[1.1-2.4]), absence of third trimester severe hypoglycaemia (3.0[1.2-7.3]), the use of insulin lispro (3.1[0.9-10.4]), weight gain during pregnancy (1.1[1.0-1.2]) anti non-smoking (2.8[0.9-9.3]). Third trimester HbA(1c) was the most powerful predictor for the occurrence of macrosomia, but its predictive capacity was weak (explained variance <5%). Conclusion/interpretation. Despite apparent good glycaemic control, the incidence of foetal macrosomia in this non-selected prospective nationwide cohort of 289 Type I diabetic women was very high. Third trimester HbA(1c) was the most powerful predictor, but its predictive capacity was weak. Thus, future research should focus on new more detailed glucose monitoring techniques (such as a continuous glucose monitoring system) as well as to alternative factors to reduce macrosomia.
引用
收藏
页码:1484 / 1489
页数:6
相关论文
共 37 条
[1]  
[Anonymous], 2000, DIABETES TECHNOLOGY, DOI DOI 10.1089/15209150050214159
[2]   The reliability of perinatal and neonatal mortality rates: differential under-reporting in linked professional registers vs. Dutch civil registers [J].
Anthony, S ;
van der Pal-de Bruin, KM ;
Graafmans, WC ;
Dorrepaal, CA ;
Borkent-Polet, M ;
van Hemsel, OJS ;
Jansen, FHM ;
den Ouden, AL .
PAEDIATRIC AND PERINATAL EPIDEMIOLOGY, 2001, 15 (03) :306-314
[3]  
BERK MA, 1989, PEDIATRICS, V83, P1029
[4]   Effect of low-level basal plus marked ''pulsatile'' hyperglycemia on insulin secretion in fetal sheep [J].
Carver, TD ;
Anderson, SM ;
Aldoretta, PW ;
Hay, WW .
AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM, 1996, 271 (05) :E865-E871
[5]   Maternal nutritional status, diabetes and risk of macrosomia among Native Canadian women [J].
Caulfield, LE ;
Harris, SB ;
Whalen, EA ;
Sugamori, ME .
EARLY HUMAN DEVELOPMENT, 1998, 50 (03) :293-303
[6]  
DAMM P, 2001, 33 ANN M DIAB PREGN, P39
[7]   THE CLASSIFICATION AND DEFINITION OF THE HYPERTENSIVE DISORDERS OF PREGNANCY [J].
DAVEY, DA ;
MACGILLIVRAY, I .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1988, 158 (04) :892-898
[8]  
*DCCT GROUP, 1998, NEW ENGL J MED, V329, P977
[9]   FETAL GLUCOSE-METABOLISM AND OXYGEN-CONSUMPTION DURING SUSTAINED HYPOGLYCEMIA [J].
DIGIACOMO, JE ;
HAY, WW .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1990, 39 (02) :193-202
[10]  
DJERF P, 2000, 32 ANN M DIAB PREGN, P38