Long-term Cognitive Implications of Intrauterine Hyperglycemia in Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study)

Bytoft, Birgitte; Knorr, Sine; Vlachová, Zuzana; Jensen, Rikke Beck; Mathiesen, Elisabeth R.; Beck‐Nielsen, Henning; Gravholt, Claus Højbjerg; Jensen, Dorte Møller; Clausen, Tine D.; Mortensen, Erik Lykke; Damm, Peter

doi:10.2337/dc16-0168

Cited by 33 publications

(34 citation statements)

References 42 publications

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“…Fetal growth can be evaluated as the birth weight SD score from the mean birth weight of a local cohort of infants adjusted for sex and gestational age. During the past 20 years, the average SD score of the newborns of women with type 1 diabetes has declined from 1.78 (21,48) in Denmark to a recent value of 1.0 (47) at our center. Despite this improvement in the average fetal size, the prevalence of LGA infants is still 40-50% in our and other populations (44,49).…”

Section: Fetal Overgrowth: the Role Of Maternal Gestational Weight Gainmentioning

confidence: 62%

Pregnancy Outcomes in Women With Diabetes—Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture

Mathiesen

2016

Diabetes Care

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Among women with diabetes, the worst pregnancy outcome is seen in the subgroup of women with diabetic nephropathy. Development of severe preeclampsia that leads to early preterm delivery is frequent. Predictors and pathophysiological mechanisms for the development of preeclampsia among women with diabetes and observational studies that support antihypertension treatment for pregnant women with microalbuminuria or diabetic nephropathy preventing preeclampsia and early preterm delivery are presented here. Obtaining and maintaining strict glycemic control before and during pregnancy is paramount to prevent preterm delivery. The cornerstones of diabetes management are appropriate diet and insulin, although the risk of severe hypoglycemia always needs to be taken into account when tailoring a diabetes treatment plan. Pathophysiological mechanisms of the increased risk of hypoglycemia during pregnancy are explored, and studies evaluating the use of insulin analogs, insulin pumps, and continuous glucose monitoring to improve pregnancy outcomes and to reduce the risk of severe hypoglycemia in pregnant women with type 1 diabetes are reported. In addition to strict glycemic control, other factors involved in fetal overgrowth are explored, and restricting maternal gestational weight gain is a promising treatment area. The optimal carbohydrate content of the diet is discussed. In summary, the lessons learned from this clinical research are that glycemic control, gestational weight gain, and antihypertension treatment all are of importance for improving pregnancy outcomes in pregnant women with preexisting diabetes. An example of how to use app technology to share the recent evidence-based clinical recommendations for women with diabetes who are pregnant or planning pregnancy is given.

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Section: Fetal Overgrowth: the Role Of Maternal Gestational Weight Gainmentioning

confidence: 62%

Pregnancy Outcomes in Women With Diabetes—Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture

Mathiesen

2016

Diabetes Care

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“…We recently reported impaired long-term cognitive function in adolescent offspring of a well-characterized cohort of Danish women with type 1 diabetes [12]. Furthermore, we found increased frequencies of learning difficulties in primary school within the group of diabetes exposed offspring.…”

Section: Introductionmentioning

confidence: 64%

“…In a recently published article on the EPICOM cohort [12], offspring exposed to maternal diabetes had lower cognitive function and higher frequency of learning difficulties in the subjects Danish and mathematics in primary school compared to the control group. Since learning difficulties and reduced academic achievement among children with attention deficits are well-known [1, 33], a potential association between maternal diabetes and attention deficits in the offspring is plausible and has been suggested in previous studies [8–11].…”

Section: Discussionmentioning

confidence: 99%

“…We have previously shown that both groups had intelligence scores above the population mean indicating selection from the better performing part of the population [12], which also might apply for the continuous performance test used to assess attention deficits. A systematic difference of participation between our groups would most likely be associated to positive selection of the control group, implying larger group differences.…”

Section: Discussionmentioning

confidence: 99%

“…All non-completions of the test (n = 9 in the diabetes exposed group, n = 10 in the control group) were due to technical difficulties related to computer problems. The inclusion process and the follow-up study have recently been described in detail [12, 25]. …”

Section: Methodsmentioning

confidence: 99%

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Assessment of Attention Deficits in Adolescent Offspring Exposed to Maternal Type 1 Diabetes

et al. 2017

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ObjectiveThe aim of this study was to examine the potential association between intrauterine exposure to maternal diabetes and attention deficits in the offspring.Research design and methodsAdolescent offspring of a prospectively followed cohort of women with type 1 diabetes (n = 269) and a control group from the background population (n = 293) participated in a follow-up assessment in 2012–2013. We used scores from Conners Continuous Performance Test II to assess attention and based on a principal component analysis we evaluated scores on five different attention factors: focused attention, vigilance, hyperactivity/impulsivity, sustained attention and response style.ResultsA higher frequency of the exposed offspring had a parent/self-reported use of Attention Deficit Hyperactivity Disorder (ADHD) medication compared to the control group (2.2% vs. 0.0%, p = 0.01). Clinical significant differences between adolescents exposed to maternal diabetes and unexposed controls were not found in either single scores on Conners Continuous Performance Test or on any of the five attention factors identified.ConclusionsExposure to maternal type 1 diabetes did not seem to increase the risk of attention deficits in the adolescent offspring. However, a higher self-reported use of ADHD medication in the exposed group could suggest a difference in attention not revealed by the applied test.

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Management of Preexisting Diabetes in Pregnancy

Alexopoulos

Blair

Peters

2019

JAMA

116

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Importance: The presence of preexisting type 1 or type 2 diabetes in pregnancy increases the risk of adverse maternal and neonatal outcomes, such as preeclampsia, caesarian section, pre-term delivery, macrosomia and congenital defects. Approximately 0.9% of the 4,000,000 births in the United States are complicated by preexisting diabetes. Observations: Women with diabetes have increased risk for adverse maternal and neonatal outcomes and similar risks are present for either type 1 or type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies, and to minimize risk of congenital defects. Hemoglobin A1c goal at conception is <6.5% and during pregnancy is <6.0%. It is also critical to screen for and optimize comorbid illnesses such as retinopathy and nephropathy. Medications known to be unsafe in pregnancy, such as angiotensin-converting enzyme inhibitors and statins, should be discontinued. Obese women should be screened for obstructive sleep apnea, which is often undiagnosed and can result in poor outcomes. Blood pressure goals must be considered carefully, as lower treatment thresholds may be required for women with nephropathy. During pregnancy, continuous glucose monitor use can improve glycemic control and neonatal outcomes for women with type 1 diabetes. Insulin is first-line therapy for all women with preexisting diabetes; injections and insulin pump therapy are both effective approaches. Rates of severe hypoglycemia are increased during pregnancy; therefore glucagon should be available and close contacts trained in its use. Low-dose aspirin is recommended soon after 12 weeks of gestation to minimize the risk of preeclampsia. The importance of discussing long-acting reversible contraception before and after pregnancy cannot be overstated, to allow for appropriate preconception planning. Conclusions and Relevance: Preexisting diabetes in pregnancy is complex and is associated with significant maternal and neonatal risk, but optimization of glycemic control, medication regimens and careful attention to comorbid conditions can help mitigate these risks, and ensure quality diabetes care before, during and after pregnancy.

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Long-term Cognitive Implications of Intrauterine Hyperglycemia in Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study)

Cited by 33 publications

References 42 publications

Pregnancy Outcomes in Women With Diabetes—Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture

Pregnancy Outcomes in Women With Diabetes—Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture

Assessment of Attention Deficits in Adolescent Offspring Exposed to Maternal Type 1 Diabetes

Management of Preexisting Diabetes in Pregnancy

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