Double diabetes as an effect modifier for adverse perinatal outcome in pregnant women with type 1 diabetes mellitus – a retrospective multicenter cohort study

Frontiers in Endocrinology

Endocrinology

Ewa Romejko-Wolniewicz¹  Zuzanna Handziuk¹  Krzysztof Czajkowski¹  Aneta Malinowska-Polubiec¹  Iwona Towpik²  Agnieszka Zawiejska³  Jacek Brązert⁴  Grzegorz Poprawski⁵ 

[1] 2 Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland;Department of Internal Medicine, Diabetology and Endocrinology, University of Zielona Gora, Zielona Gora, Poland;Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, Poznan, Poland;Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland;Oncological Gynecology Department, Poznan University of Medical Sciences, Poznan, Poland;

关键词: pregnancy;    obesity;    metabolic syndrome;    neonatal outcome;    maternal outcome;   

DOI  :  10.3389/fendo.2023.1215407

 received in 2023-05-01, accepted in 2023-07-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionDouble diabetes (DDiab) is defined as T1DM coexisting with insulin resistance (IR), metabolic syndrome (MetS), and/or obesity. Little evidence is available regarding how frequent DDiab is among T1DM pregnancies and whether it affects the perinatal outcome in this population.Aims of the studyTo explore the prevalence of DDiab in early pregnancy in the cohort of pregnant women with T1DM and to examine the association between an early-pregnancy DDiab status and fetomaternal complications characteristic for T1DM in pregnancy.Material and methodsA retrospective data analysis of the multicenter cohort of N=495 pregnant women in singleton pregnancy complicated with T1DM followed from early pregnancy until delivery in three tertiary referral centers. DDiab status was defined as T1DM plus pre-pregnancy obesity defined as BMI≥30 kg/m2 measured at the first antenatal visit (DDiabOb), or T1DM plus pre-pregnancy IR defined as eGDR (estimated Glucose Disposal Rate) below the 25th centile for the cohort measured at the first antenatal visit (DDiabIR). Proportions of the adverse pregnancy outcomes were compared between DDiabOb and Non-DDiabOb and between DDiabIR and Non-DDiabIR patients.Characteristics of the study group(data presented as mean(SD) or percentage): age: 30.0(5.1) years; age when T1DM diagnosed: 17.5(8.5) years; T1DM duration: 12.0(7,9) years; microvascular complications (White classes R,F,RF): 11.9%, pre-pregnancy counselling: 26.6%, baseline gestational age: 10.5(4.3) weeks, pre-pregnancy BMI: 23.7(4.3) kg/m2; chronic hypertension: 9.1%, gestational hypertension (PIH) 10.7%, preeclampsia (PET): 3.2%; nulliparity 53.8%, smoking in pregnancy: 4.8%, eGWG: 22.4%, DDiabOB: 10.1%; DdiabIR: 25.2%; LGA: 44.0%, and NICU admission: 20.8%.Results(data from the univariate analysis given as OR(95%CI)): both DDiabOB and DDiabIR status increased the risk for eGWG [23.15 (10.82; 55.59); 3.03 (1.80; 5.08), respectively]. DDiabIR status increased the risk for PET [4.79 (1.68;14.6)], preterm delivery [1.84 (1.13; 3.21)], congenital malformation [2.15 (1.07;4.25)], and NICU hospitalization [2.2 (1.20;4.01)]. Both DDiabOB and DDiabIR accurately ruled out PET (NPV 97.3%/98.3%, accuracy: 88.3%/75.6%, respectively), congenital malformation (NPV 85.6%/88.4%, accuracy: 78.9/69.8, respectively), and perinatal mortality (NPV 98.7%/99.2%, accuracy: 88.8%/74.5%, respectively).ConclusionsDouble diabetes became a frequent complication in T1DM pregnant population. Double diabetes diagnosed in early pregnancy allows for further stratification of the T1DM pregnant population for additional maternal risk.

【 授权许可】

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Copyright © 2023 Malinowska-Polubiec, Zawiejska, Romejko-Wolniewicz, Poprawski, Towpik, Brązert, Handziuk and Czajkowski