Glucose variability as the risk factor of preeclampsia in pregnant patients with type 1 diabetes mellitus

Tiselko, Alena V.; Kapustin, Roman V.; Milyutina, Yu. P.; Borovik, Natalia V.; Abashova, Elena I.; Yarmolinskaya, Maria I.

doi:10.1080/14767058.2022.2050361

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…Six prospective observational cohort studies (including two secondary analyses of randomized controlled trials evaluating CGM therapy) and 33 retrospective cohort studies published from 2010 to 2022 met inclusion criteria and were selected for the systematic review (Figure 1 and Table 1). 8,18-55 In aggregate, the 39 studies included in the systematic review included 7528 pregnancies.…”

Section: Resultsmentioning

confidence: 99%

“…19,21,30,34,38,39,43,45,46,48,49 The remaining 28 studies compared perinatal outcomes according to each insulin administration modality among 5518 pregnant persons (3282 [59.5%] MDI vs 2,236 [40.5%] CSII) with pregestational DM and were quantitatively synthesized in the meta-analysis. 8,18,20,[22][23][24][25][26][27][28][29][31][32][33][35][36][37][40][41][42]47,[50][51][52][53][54][55] For the primary maternal outcome, CSII therapy was associated with greater odds of CD (20 studies: 63.24% vs 56.49%, OR 1.33 [95% CI 1.15-1.54]; Figure 2), with no significant heterogeneity between studies (I 2 = 0.0%, P = .58). We confirmed the robustness of this positive association LGA, birthweight…”

Section: Meta-analysis and Synthesis Of Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Maternal age and BMI appear similar between users of CSII and MDI, though in many studies, those using CSII had pregestational DM for more years and higher rates of microvascular complications than those using MDI. In addition, 12 studies reported on tobacco use, 18,24,26,28,30,32,[35][36][37]41,50,55 four studies reported on preconception folic acid intake, 24,26,28,56 six studies reported on individuals having a history of diabetic neuropathy, 26,28,42,46,52,45 two studies reported on need for hospitalization for glycemic control, 22,26 seven studies reported on change in hemoglobin A1c from the first to third trimester, 27,28,42,45,46,48,55 and four studies reported on the change in daily insulin dose from the first to third trimester. 18,21,36,55 Tables 2 and 3 detail obstetric outcomes and other outcomes related to neonatal size (eg, birthweight, SGA, LGA, macrosomia, and shoulder dystocia) according to insulin administration modality, with 32 studies reporting on frequency of CD as the primary maternal outcome of interest.…”

Section: Study Characteristics and Systematic Reviewmentioning

confidence: 99%

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Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Fisher

Huang

DuBord

et al. 2023

J Diabetes Sci Technol

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Background: The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM. Methods: A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models. Results: Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI. Conclusions: Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Meta-analysis and Synthesis Of Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristics and Systematic Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Fisher

Huang

DuBord

et al. 2023

J Diabetes Sci Technol

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“…Few studies have investigated associations between glycemic control assessed by CGM and PE. In a recently published study by Tiselkov et al., 25 glucose variability was studied by using CGM in 200 women with type 1 diabetes. In that study, the risk of PE was significantly increased if the woman was hyperglycemic more than 25% of the time.…”

Section: Discussionmentioning

confidence: 99%

Glycemic control assessed by continuous glucose monitoring during pregnancy in women with type 1 diabetes and its association with preeclampsia, an observational Swedish cohort study

Englund Ögge,

Dotevall,

Elfvin

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionWomen with type 1 diabetes have an increased risk of preeclampsia (PE), but it is not fully understood if degree of glycemic control is associated with this risk. The aim of this study was to assess glycemic control during pregnancy analyzed by continuous glucose monitoring (CGM) in women with and without PE and to investigate if glycemic control is associated with increased risk of PE.Material and MethodsA total of 120 pregnant Swedish women with type 1 diabetes using CGM were included. Background factors and pregnancy outcomes were collected from medical records. CGM data were collected via the internet‐based platform Diasend. Mean glucose, standard deviation of mean glucose, percentage of time in target, time below target, and time above target were presented for each trimester in women who did or did not develop PE. Associations between CGM‐derived metrics and PE were analyzed with logistic regression and adjusted for confounders.ResultsTwenty‐two women (18.3%) developed PE. There were no significant differences in maternal characteristics between women with and without PE. Glycemic control improved in each trimester but was suboptimal in both groups. Time in target increased from 59% in the non‐PE group and 54% in the PE group in the first trimester to 65% in both groups in the third trimester. There were no significant associations between glycemic control and PE after adjustment for confounders.ConclusionsDegree of glycemic control during pregnancy assessed by CGM was not associated with development of PE in women with type 1 diabetes. However, more research is needed to understand the role of glycemic control in relation to development of PE.

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A Review of Third-Trimester Complications in Pregnancies Complicated by Diabetes Mellitus

Welsey,

Day,

Sullivan

et al. 2024

Am J Perinatol

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Pregnancies affected by both pregestational and gestational diabetes mellitus carry an increased risk of adverse maternal and neonatal outcomes. While the risks associated with diabetes in pregnancy have been well documented and span across all trimesters, maternal and neonatal morbidity have been associated with select third-trimester complications. Further, modifiable risk factors have been identified that can help improve pregnancy outcomes. This review aims to examine the relationship between select third-trimester complications (large for gestational age, intrauterine fetal demise, hypertensive disorders of pregnancy, preterm birth, perineal lacerations, shoulder dystocia, and cesarean delivery) and the aforementioned modifiable risk factors, specifically glycemic control, blood pressure control, and gestational weight gain. It also highlights how early optimization of these modifiable risk factors can reduce adverse maternal, fetal, and neonatal outcomes. Key Points

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Glucose variability as the risk factor of preeclampsia in pregnant patients with type 1 diabetes mellitus

Cited by 7 publications

References 19 publications

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Glycemic control assessed by continuous glucose monitoring during pregnancy in women with type 1 diabetes and its association with preeclampsia, an observational Swedish cohort study

A Review of Third-Trimester Complications in Pregnancies Complicated by Diabetes Mellitus

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