Risk factors for large-for-gestational age infants in pregnant women with type 1 diabetes

BMC Pregnancy and Childbirth

Research Article

Chantal Mathieu¹  Katrien Benhalima¹  Astrid Morrens¹  Roland Devlieger²  Johan Verhaeghe²  Christine Vanhole³ 

[1] Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium;Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium;Department of Pediatrics, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium;

关键词: Type 1 diabetes;    Pregnancy;    Weight gain;    Large-for-gestational age infants;   

DOI  :  10.1186/s12884-016-0958-0

 received in 2015-12-12, accepted in 2016-07-09,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe rate of neonatal overweight remains generally high in type 1 diabetes (T1DM). Since glycemic control has improved over time other contributors need to be identified. Our aim is to evaluate the risk factors for large-for-gestational age infants (LGA) in women with T1DM and to evaluate whether the rate of LGA decreased over time.MethodsRetrospective analysis of the medical files of pregnant women with T1DM attending our university hospital form 01-01-1992 till 31-07-2014. The generalized mixed model was used to adjust for several pregnancies over time in the same women. A multivariable model was used to evaluate independent risk factors for LGA.ResultsOver a 22-year period, 259 pregnancies in 180 T1DM women were identified. Mean diabetes duration of women was 13.7 ± 7.1 years, with a mean age of 29.5 ± 5.2 years. Macrosomia (>4Kg) was present in 16.2 % of deliveries, LGA was present in 45.2 % and these numbers did not change over time (resp. p = 0.19 and p = 0.70). Over time, significant more women were overweight (23.3 % vs. 39.3 %, p = 0.009) and more women had excessive weight gain during pregnancy (21.3 % vs. 37.7 %, p = 0.019). Compared to women with a non-LGA baby, women with a LGA baby had a higher weight at delivery (84.1 ± 11.1 vs. 80.4 ± 10.8, p = 0.016), had more often excessive weight gain (45.3 % vs. 25.2 %, p = 0.003) and had less strict glycaemic control in the first and third trimester [HbA1c of resp. 49 ± 10 mmol/mol (6.7 % ±0.9) vs. 47 ± 8 mmol/mol (6.5 % ±0.8), p = 0.01 and 44 ± 5 mmol/mol (6.2 % ±0.5) vs. 42 ± 6 mmol/mol (6.0 % ±0.6), p = 0.01]. In the forward multivariable analysis, excessive weight gain [OR 1.95 (1.08–3.53), p = 0.027], HbA1c level in early [OR 1.43 (1.05–1.95), p = 0.023] and late pregnancy [OR 1.70 (1.07–2.71), p = 0.026] remained independent predictors for LGA.ConclusionsLGA remains a frequent complication in T1DM. Excessive weight gain and HbA1c in early and late pregnancy are important risk factors for LGA in our population. These findings highlight the importance of strict maternal glycemic control and simultaneous striving to appropriate gestational weight gain to minimize the risk of fetal overgrowth in T1DM pregnancies.

【 授权许可】

CC BY   
© The Author(s). 2016