Gestational weight gain in women with type 1 and type 2 diabetes mellitus is related to both general and diabetes-related clinical characteristics.

PURPOSE: To assess predictors of gestational weight gain (GWG), according to the Institute of Medicine (IOM) 2009, in women with type 1 and type 2 diabetes. METHODS: This was a retrospective cohort study conducted at a tertiary center. GWG based on the IOM was assessed both uncorrected and corrected for gestational age. General and diabetes-related clinical characteristics were analyzed as predictors. RESULTS: We evaluated 633 pregnant women with type 1 and type 2 diabetes. GWG uncorrected for gestational age was inadequate (iGWG) in 20.4%, adequate in 37.1%, and excessive (eGWG) in 42.5% of the women. Predictors included general (height, prepregnancy body mass index category, and multiple pregnancy) and diabetes-related clinical characteristics. Neuropathy and follow-up length were associated with iGWG (odds ratio (OR) 3.00, 95% CI 1.22-7.37; OR 0.92, 95% CI 0.86-0.97, respectively), while pump use and third-trimester insulin dose were associated with eGWG (OR 1.68, 95% CI 1.07-2.66; OR 3.64, 95% CI 1.88-7.06, respectively). Independent predictors for corrected GWG and sensitivity analyses also included general and diabetes-related clinical characteristics. CONCLUSION: In this cohort of women with type 1 and type 2 diabetes, non-adequate GWG was common, mainly due to eGWG, and associated clinical characteristics were both general and diabetes-related. Current clinical care of these women during pregnancy may favor weight gain.

Gestational weight gain and pregnancy outcomes in women with type 1 and type 2 diabetes mellitus.

AIMS: We aimed to explore the relationship between gestational weight gain (GWG) after Institute of Medicine (IOM) and pregnancy outcomes in women with type 1 and type 2 diabetes. METHODS: Retrospective cohort study at a tertiary medical center (1981-2011). OUTCOME VARIABLES: 2 maternal and 14 fetal. Main exposure variable: GWG according to IOM. We calculated crude and adjusted ORs as well as population attributable (PAF) and preventable fractions (PPF) for significant positive and negative associations, respectively. RESULTS: We evaluated 633 pregnant women with type 1 or type 2 diabetes. GWG was insufficient (iGWG) in 16.7% and excessive (eGWG) in 50.7%. In the adjusted analysis, GWG according to IOM was significantly associated with maternal outcomes (pregnancy-induced hypertension and cesarean delivery) and four fetal outcomes (large-for-gestational age, macrosomia, small-for-gestational age and neonatal respiratory distress). The association with large-for-gestational age newborns was negative for iGWG (0.48, CI 95% 0.25-0.94) and positive for eGWG (1.76, CI 95% 1.18-2.63). In addition, iGWG was associated with a higher risk of small-for-gestational age newborns and respiratory distress and eGWG with a higher risk of pregnancy-induced hypertension, caesarean delivery and macrosomia. PAF and PPF ranged from the 20.4% PPF of iGWG for large-for-gestational age to 56.5% PAF of eGWG for macrosomia. CONCLUSION: In this cohort of women with type 1 or type 2 diabetes, inadequate GWG after IOM was associated with adverse pregnancy outcomes; associations were unfavorable for eGWG and mixed for iGWG. The attributable fractions were not moderate, pointing to the potential impact of modifying inadequate GWG.

Both glycaemic control and insulin dose during pregnancy in women with type 1 diabetes are associated with neonatal anthropometric measures and placental weight.

BACKGROUND: To investigate longitudinal associations of maternal glucose/HbA1c and insulin dose with birthweight-related outcomes in women with type 1 diabetes. METHODS: We performed a cohort study including 473 pregnant women with type 1 diabetes with singleton pregnancies. We investigated maternal self-monitored blood glucose (SMBG, mmol/L), HbA1c (%, mmol/mol) and insulin dose (IU/kg/day) in the three trimesters as potential independent variables, while adjusting for potential confounders. Outcomes of interest were birthweight, birthweight SD score, neonatal length, weight/length index, ponderal index and placental weight. Multiple linear regression analysis was performed with separate analyses for SMBG and HbA1c . RESULTS: Maternal glucose and insulin dose were independently associated with birthweight-related outcomes. In the main analysis, in the first trimester most associations were positive for insulin dose, in the second the associations were positive for glucose and inverse for insulin while in the third there were no associations. Most sensitivity analyses produced consistent results. In a sensitivity analysis splitting the first trimester in two periods, positive associations of maternal insulin with birthweight-related outcomes were observed in weeks 0+ to 6+. CONCLUSIONS: Early in pregnancy in women with type 1 diabetes, maternal insulin dose is positively associated with birthweight-related outcomes, whereas in the second trimester, a positive association with SMBG emerges and the association with maternal insulin becomes inverse. If confirmed in other cohorts, these results would have implications in the management of women with type 1 diabetes.

Sex ratio at birth is associated with type 1 diabetes characteristics.

AIMS: To assess the association between maternal diabetes characteristics and sex ratio at birth (SRB) in women with type 1 diabetes mellitus. METHODS: We performed a case-control study. The study subjects were infants born alive to women with type 1 diabetes and singleton pregnancies. Cases and controls were defined as male and female newborns, respectively. SRB was analysed according to diabetes-related characteristics adjusting in a logistic regression analysis for maternal characteristics known to affect SRB in the general population. RESULTS: The observed SRB (238 males/468 live births = 0.509) did not differ from the expected. In the logistic regression analysis, SRB was significantly associated with three diabetes characteristics: (1) diabetes duration, with odds ratios (ORs) for a live male newborn = 1.22 (95 % confidence interval (CI), 0.66-2.24 for ≤5 years, OR 2.79 (95 % CI 1.36-5.74) for >20 years; (2) mean first-trimester glycated haemoglobin, with OR 1.98 (95 % CI 1.09-3.62) for ≤6.7 % (50 mmol/mol) and OR 2.61 (95 % CI 1.16-5.85) for >8.2 % (66 mmol/mol) and (3) mean first-trimester insulin dose, with OR 0.70 (95 % CI 0.36-1.38) for ≤0.5 IU/kg/day and OR 0.18 (95 % CI 0.05-0.59) for >1.0 IU/kg/day. CONCLUSIONS: We conclude that SRB in this cohort is independently associated with three diabetes characteristics. These associations are to be confirmed.

Diabetes mellitus gestacional y etnia materna: alta prevalencia de macrosomía fetal en mujeres no caucásicas / Gestational diabetes mellitus and maternal ethnicity: high prevalence of fetal macrosomia in non-Caucasian women

Fundamento y objetivo: En gestantes con diabetes mellitus gestacional (DMG) se han descrito diferencias en los resultados perinatales según la etnia materna. El objetivo de este estudio fue analizar la relación entre etnia, características maternas y resultados perinatales en mujeres con DMG en nuestro medio.Pacientes y método: Análisis retrospectivo de mujeres con DMG atendidas en el período 1986-2007. Se estudiaron 2.543 parejas madre-hijo (8,9% gestaciones múltiples, 2.480 mujeres caucásicas [C] y 63 no caucásicas [NC]). Se compararon las características maternas y los resultados perinatales según la etnia materna y se realizaron regresiones logísticas multivariantes (backward) para predecir los resultados perinatales. Resultados: Los 2 grupos (C frente a NC) difirieron en gestaciones previas, antecedentes obstétricos, índice de masa corporal pregestación, retraso de entrada en clínica, glucemia basal al diagnóstico y hemoglobina glucosilada inicial y en el tercer trimestre, todos más desfavorables en el grupo NC. En resultados perinatales se observaron diferencias en la prevalencia de recién nacidos macrosomas (4,3 frente a 19,4%) y grandes para la edad gestacional (GEG) (9,5 frente a 32,3%), más elevada en el grupo NC. En los análisis de regresión logística, NC fue un predictor independiente de macrosomía, GEG e ictericia, con odds ratio que oscilaron entre 2,767 (intervalo de confianza del 95% [IC 95%] 1,257-6,091) para GEG y 3,629 (IC 95% 0,972-13,548) para ictericia neonatal. Conclusiones: Las pacientes NC con DMG presentaron resultados perinatales más desfavorables que se explicaron solo parcialmente por los antecedentes, datos antropométricos y control glucémico materno. La etnia NC fue un predictor independiente de resultados perinatales desfavorables (AU)

Background and objective: Differences in perinatal outcomes according to ethnicity have been described in pregnant women with gestational diabetes mellitus (GDM). We analysed the relationship between ethnicity, maternal characteristics and perinatal outcomes in pregnant women with GDM.Patients and methods: Retrospective analysis of women with GDM attended at the centre between 1986 and 2007. We studied 2,543 mother-infant pairs (8.9% multiple pregnancies, 2,480 Caucasian [C] and 63 non-Caucasian [NC] mothers). Maternal characteristics and perinatal outcomes were compared according to maternal ethnicity and multivariable logistic regression analyses (backward method) were performed to predict perinatal outcomes. Results: The groups (C vs NC) differed in previous pregnancies, obstetric history, pregestational body mass index, delay between diagnosis and clinic entry, fasting plasma glucose at diagnosis and both initial and third trimester glycated hemoglobin, with all of them being worse in NC group. As to perinatal outcomes, we also observed differences in the prevalence of macrosomic (4.3 vs 19.4%) and large for gestational age newborns (LGA) (9.5 vs 32.3%), all of them being higher in the NC group. In the logistic regression analyses, NC was an independent predictor of macrosomia, LGA and jaundice with odds ratio ranging from 2.767 (95% confidence interval [95% CI] 1.257-6.091) for LGA and 3.629 (95% CI 0.972-13.548) for neonatal jaundice. Conclusions: NC-GDM patients had more adverse perinatal outcomes only partially explained by medical history, anthropometric data and maternal glycemic control. NC ethnicity was an independent predictor of poor perinatal outcomes (AU)

Sex ratio at birth is associated with first-trimester maternal thyrotropin in women receiving levothyroxine.

BACKGROUND: The sex ratio at birth (male out of total alive newborns) is historically established at 0.515 and is influenced by numerous factors. It is not known, however, whether it is influenced by maternal thyroid conditions. Our aim was to analyze its association with maternal thyroid autoimmunity and first-trimester thyrotropin (TSH). METHODS: We performed a retrospective cohort study at a tertiary care center. We studied 167 women who had received pregestational treatment with levothyroxine for hypothyroidism or differentiated thyroid carcinoma and gave birth to live infants. Women with secondary/tertiary hypothyroidism, pregestational diabetes mellitus, or multiple pregnancies were excluded. Autoimmunity was defined as present/absent, and mean first-trimester TSH was tested both as a quantitative variable and using six predefined categories. The outcome measure was sex ratio at birth. RESULTS: The sex ratio at birth was 0.485, not significantly different from expected. Maternal characteristics were similar in mothers of female and male newborns with the exception of mean first-trimester TSH, which was higher in pregnancies of female fetuses (3.27 vs. 2.52 mUI/L, p<0.025). Newborn sex differed across predefined TSH categories (p<0.021, with a sex ratio of 0.200 [95% confidence interval 0.00-0.402] for TSH ≥10 mUI/L). A multiple logistic regression analysis to predict newborn male sex confirmed maternal mean first-trimester TSH as the single predictor (odds ratio 0.900 [95% confidence interval 0.823-0.984], p<0.020). CONCLUSIONS: In women under pregestational treatment with levothyroxine, mean maternal first-trimester TSH is negatively associated with sex ratio at birth. This association has not been previously described.

[Gestational diabetes mellitus and maternal ethnicity: high prevalence of fetal macrosomia in non-Caucasian women]. / Diabetes mellitus gestacional y etnia materna: alta prevalencia de macrosomía fetal en mujeres no caucásicas.

BACKGROUND AND OBJECTIVE: Differences in perinatal outcomes according to ethnicity have been described in pregnant women with gestational diabetes mellitus (GDM). We analysed the relationship between ethnicity, maternal characteristics and perinatal outcomes in pregnant women with GDM. PATIENTS AND METHODS: Retrospective analysis of women with GDM attended at the centre between 1986 and 2007. We studied 2,543 mother-infant pairs (8.9% multiple pregnancies, 2,480 Caucasian [C] and 63 non-Caucasian [NC] mothers). Maternal characteristics and perinatal outcomes were compared according to maternal ethnicity and multivariable logistic regression analyses (backward method) were performed to predict perinatal outcomes. RESULTS: The groups (C vs NC) differed in previous pregnancies, obstetric history, pregestational body mass index, delay between diagnosis and clinic entry, fasting plasma glucose at diagnosis and both initial and third trimester glycated hemoglobin, with all of them being worse in NC group. As to perinatal outcomes, we also observed differences in the prevalence of macrosomic (4.3 vs 19.4%) and large for gestational age newborns (LGA) (9.5 vs 32.3%), all of them being higher in the NC group. In the logistic regression analyses, NC was an independent predictor of macrosomia, LGA and jaundice with odds ratio ranging from 2.767 (95% confidence interval [95% CI] 1.257-6.091) for LGA and 3.629 (95% CI 0.972-13.548) for neonatal jaundice. CONCLUSIONS: NC-GDM patients had more adverse perinatal outcomes only partially explained by medical history, anthropometric data and maternal glycemic control. NC ethnicity was an independent predictor of poor perinatal outcomes.

Maternal body mass index is a predictor of neonatal hypoglycemia in gestational diabetes mellitus.

CONTEXT: In diabetic pregnancy, neonatal hypoglycemia (NH) is usually attributed to insufficient regulation of maternal glycemic control. Recent data suggest that maternal body mass index (BMI) could have an influence. OBJECTIVE: Our objective was to determine whether an association exists between maternal prepregnancy BMI category and occurrence of NH among infants born to women with gestational diabetes mellitus (GDM). DESIGN AND SETTING: This was a retrospective study including all GDM pregnancies delivered between 1986 and 2006 at a tertiary care center (Hospital de la Santa Creu i Sant Pau, Barcelona). PATIENTS AND OUTCOMES: GDM was diagnosed using universal screening and National Diabetes Data Group criteria. Two thousand ninety-two newborns (1925 singletons, 85% of total GDM offspring) were studied. NH was defined according to Cornblath criteria. In addition to maternal BMI, we considered other variables such as glucose values at diagnosis or third-trimester glycated hemoglobin as potential predictors of NH. We explored whether the association between maternal BMI and NH could be due to intermediate steps such as cesarean section or abnormal birth weight. RESULTS: The rate of NH was 3%. In the bivariate analysis, prepregnancy BMI was higher in the NH group (24.45 vs. 23.19 kg/m(2), P < 0.02). In the logistic regression analysis, prepregnancy BMI of at least 25 kg/m(2) was independently associated with NH whether the analysis included intermediate variables (odds ratio = 2.11; 95% confidence interval = 1.10-4.03) or not (odds ratio = 2.66; 95% confidence interval = 1.44-4.92). CONCLUSIONS: Pregestational BMI should be considered among the predictors of NH in offspring of women with GDM.

Are birth weight predictors in diabetic pregnancy the same in boys and girls?

OBJECTIVES: To study the predictors of abnormal fetal growth in diabetic pregnancy, analyzing the role of fetal sex. STUDY DESIGN: Observational retrospective study was carried out in a University hospital. We studied 2833 newborns of diabetic mothers who attended the Diabetes and Pregnancy Clinic and delivered in the center between 1/1/1982 and 31/12/2006 (2370 born to women with gestational diabetes mellitus, 391 to women with type 1 diabetes mellitus (DM), and 72 to women with type 2 DM). Logistic regression analyses were performed with a backward method to predict large for gestational age (LGA), small for gestational age (SGA) and macrosomic newborns using relevant variables and their interaction with fetal sex. We have used as potential predictors of abnormal birth weight: maternal prepregnancy age, weight, height and body mass index, prior pregnancy, prior macrosomia, smoking habit, weight increase during pregnancy, hypertension, gestational age at delivery, twin pregnancy, fetal sex, diabetes type, third trimester HbA1c and interaction of fetal sex with all these variables. RESULTS: Variables predictive of LGA, SGA and macrosomia were as formerly described. Moreover, some predictors of abnormal growth displayed an interaction with fetal sex. In LGA prediction, male sex displayed a positive interaction with delivery week, prior gestation, diabetes type and twin pregnancy and a negative one with weight increase. In SGA prediction, male sex displayed a positive interaction with delivery week and diabetes type. In macrosomia prediction, male sex displayed a negative interaction with weight increase. CONCLUSIONS: In this cohort of diabetic pregnancies, some predictors of abnormal birth weight display interaction with fetal sex. In general, associations were more favorable to female fetuses.