Changes in the Glycemic Profiles of Women With Type 1 and Type 2 Diabetes During Pregnancy

Murphy, Helen; Rayman, Gerry; Duffield, Katherine; Lewis, Karen; Kelly, Susan; Johal, Balroop; Fowler, Duncan; Temple, Rosemary

doi:10.2337/dc07-0500

Cited by 125 publications

(100 citation statements)

References 37 publications

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“…>140 mg/dL was ‡8 h/day in women with T1D and *3 h/day in women with T2D in each trimester. 29 The Danish study of intermittent real-time CGM (rtCGM) found no differences in outcomes between groups; however, only 64% (49/76) in the rtCGM group followed the protocol. 30,31 Taken together, these studies suggest that adjunctive CGM use may help make decisions about therapy, but improvement of long-term glucose control and outcomes may require more than just intermittent use.…”

Section: <6% <6%mentioning

confidence: 99%

CGM, Pregnancy, and Remote Monitoring

Polsky

Garcetti

2017

Diabetes Technology & Therapeutics

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The glycemic goals of pregnancy are very narrow to reduce excess risks for numerous maternal and fetal complications. Continuous glucose monitors (CGMs) may help women achieve glucose goals and reduce hypoglycemia. CGM use has been found to be safe and effective in pregnancies associated with diabetes. CGM use can accurately identify glycemic patterns among women with and without diabetes in pregnancy. The data on the effects of CGM use on maternal and fetal outcomes are conflicting. Using CGMs in conjunction with continuous subcutaneous insulin infusion therapy in pregnancies complicated by diabetes may improve outcomes. There are limitations of CGM use that affect patients in and outside of pregnancy, as well as specific barriers that only affect pregnant women. Of importance, CGM use does not replace standard clinical care, but may be used an adjunctive tool in pregnancy. CGM remote monitoring in pregnancy is an understudied field. In this study, we review the studies on CGM use in pregnancy.

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Section: <6% <6%mentioning

confidence: 99%

CGM, Pregnancy, and Remote Monitoring

Polsky

Garcetti

2017

Diabetes Technology & Therapeutics

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“…Data from healthy pregnant women suggest that the mother adapts to the increasing fetal demands for glucose by increasing both the total rate of appearance of glucose and the endogenous glucose production in late gestation [1]. Women with type 1 diabetes spend on average 8 h per day in hyperglycaemia in late gestation, with most hyperglycaemic excursions following meals [2]. As the maternal and fetal glucose pools are in equilibrium [3], with a rapid transfer of glucose to the fetus according to maternal glucose concentration [4], maternal hyperglycaemia is associated with an adverse pregnancy outcome, most commonly fetal growth acceleration and increased risk of large-for-gestational-age offspring [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of postprandial hyperglycaemia in women with type 1 diabetes during pregnancy

et al. 2011

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Aims/hypothesis Although maternal hyperglycaemia is associated with increased risk of adverse pregnancy outcome, the mechanisms of postprandial hyperglycaemia during pregnancy are poorly understood. We aimed to describe glucose turnover in pregnant women with type 1 diabetes, according to stage of gestation (early vs late gestation). Methods The rates of systemic glucose appearance (R a ) and glucose disposal (R d ) were measured in ten pregnant women with type 1 diabetes during early (12-16 weeks) and late (28-32 weeks) gestation. Women ate standardised meals-a starch-rich 80 g carbohydrate dinner and a sugarrich 60 g carbohydrate breakfast-and fasted between meals and overnight. Stable-label isotope tracers ([6,6-2 H 2 ]glucose and [U-13 C]glucose) were used to determine R a , R d and glucose bioavailability. Closed-loop insulin delivery maintained stable glycaemic conditions. Results There were no changes in fasting R a (10±2 vs 11±2 μmol kg -1 min -1 ; p=0.32) or fasting R d (11±2 vs 11±1 μmol kg -1 min -1 ; p=0.77) in early vs late gestation. There was increased hepatic insulin resistance (381±237 vs 540 ± 242 μmol kg -1 min -1 × pmol/l; p = 0.04) and decreased peripheral insulin sensitivity (0.09±0.04 vs 0.05±0.02 μmol kg -1 min -1 per pmol/l dinner, 0.11±0.05 vs 0.07±0.03 μmol kg -1 min -1 per pmol/l breakfast; p=0.002) in late gestation. It also took longer for insulin levels to reach maximal concentrations (49 [37-55]

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“…In gestational diabetes mellitus the overall consensus is that intensive treatment reduces perinatal morbidity and birth weight [59]. In type 1 diabetes some randomized trials and numerous observational studies support this conclusion [11,12,[60][61][62][63][64][65][66]. Pregnancy, insulinopenia, and hyperglycemia enhance IGFBP-3 proteolysis in women with diabetes and increase levels of IGF-1.…”

Section: Glycemic Control and Macrosomiamentioning

confidence: 97%

Macrosomia and the IGF System: A Short Review

Al-Far¹,

Tjessem²,

Lauszus³

2017

Foc Sci

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Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal and fetal issues. Its incidence surpasses other critical obstetrical morbidity in diabetic pregnancy with increased placental size and polyhydramnios as comorbidity. The studies on the underlying factors contributing to macrosomia have focused on growth stimuli like IGF, glycemia, and insulin and their effects on regional organ function. IGF-I and -II in maternal serum are associated with birth weight and the bioavailabiliy is modulated by IGF-binding-proteins (IGFBP) and phosporylated isoforms of IGFBP and the presence of proteases and IGF split products. Human placental growth hormone regulates the effect of IGF-I in pregnancy. Methods: The literature on the IGF system′s possible effect on fetal growth in diabetic pregnancy is reviewed before our current studies and updated with respect to later findings. Regulation on bioavailability by proteolysis and phosporylation is described. The review discusses briefly the studies on pregnant women with type 1 diabetes with respect to vasculopathy. Results: The data show good correlation of IGF-1/2 levels with birth weight. No such correlation with IGFBP-1 and -3 is found. Fetal growth deviation in diabetic pregnancy is not uniform. In first trimester, growth delay is documented in fetal growth curves compared to non-diabetic controls. Accordingly, a shift in IGF-IGFBP regulation in second trimester is found with less proteolysis of IGFBPs and relative increase in total binding capacity. In third trimester, free IGF further increases as IGFBP binding decreases by proteolysis and modulation. The first trimester values may be used as predictor of fetal weight at term. Diabetic women show a two-to threefold increase in the in vitro IGFBP-3 proteolytic activity during pregnancy as compared to post-partum values. Conclusions: Prominent proteolysis of binding proteins and the modulation by insulin account for the mechanism leading to macrosomia. The two factors combined guarantee the stimulation by more bioavailable IGF and the glycemic levels reveal whether insulin dose are optimal. Structural factors of diabetes i.e. microangiopathy further modulate the sum of effects on fetal growth. In contrast to macrosomia, fetal growth restriction is associated with prominent maternal vascular endothelial complications, such as overt nephropathy, proliferative retinopathy, preeclampsia, and hypertension. In parallel to the growth inhibition, stimulatory effects are exerted by the GH axis including the placental growth hormones and occur probably as compensatory mechanism, similar to the increased IGFBP-3 proteolysis in late pregnancy found in growth retardation. This influence may in part explain the disproportionate growth in different tissue components occurring in the various stages of diabetic pregnancy.

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Changes in the Glycemic Profiles of Women With Type 1 and Type 2 Diabetes During Pregnancy

Cited by 125 publications

References 37 publications

CGM, Pregnancy, and Remote Monitoring

CGM, Pregnancy, and Remote Monitoring

Pathophysiology of postprandial hyperglycaemia in women with type 1 diabetes during pregnancy

Macrosomia and the IGF System: A Short Review

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