Pregestational Diabetes in Pregnancy

Sugrue, Ronan; Zera, Chloe

doi:10.1016/j.ogc.2018.01.002

“…Although the prevalence of DM was very low among reproductive-aged women, the absolute number affected by DM can be large because of the population size in China. Besides, DM has been shown to be related to substantial adverse health outcomes, such as preeclampsia, nephropathy, retinopathy, prematurity, abnormal fetal growth, spontaneous abortion, and congenital malformation [22]. Most of the current guidelines adopt glycosylated hemoglobin (HbA1c < 7.0% or 6.5% without hypoglycemia) to indicate a clinically safe point to satisfy pregnancy outcomes for women with DM or elevated blood glucose [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Wei¹,

Xu²,

Yang³

et al. 2020

ESPE

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Background Diabetes mellitus (DM) increases the risk of adverse maternal and neonatal outcomes, and optimization of glycemic control during pregnancy can help mitigate risks associated with diabetes. However, studies seldom focus precisely on maternal blood glucose level prior to pregnancy. We aimed to evaluate the associations between preconception blood fasting plasma glucose (FPG) level and subsequent pregnancy outcomes. Methods and findings We conducted a population-based retrospective cohort study among 6,447,339 women aged 20-49 years old who participated in National Free Pre-Pregnancy Checkups Project and completed pregnancy outcomes follow-up between 2010 and 2016 in China. During the preconception health examination, serum FPG concentration was measured, and selfreported history of DM was collected. Women were classified into three groups (normal FPG group: FPG < 5.6 mmol/L and no self-reported history of DM; impaired fasting glucose [IFG]: FPG 5.6-6.9 mmol/L and no self-reported history of DM; and DM: FPG � 7.0 mmol/L or self-reported history of DM). The primary outcomes were adverse pregnancy outcomes, including spontaneous abortion, preterm birth (PTB), macrosomia, small for gestational age infant (SGA), birth defect, and perinatal infant death. Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (CI) after adjusting for confounding

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“…Although the prevalence of DM was very low among reproductive-aged women, the absolute number affected by DM can be large because of the population size in China. Besides, DM has been shown to be related to substantial adverse health outcomes, such as preeclampsia, nephropathy, retinopathy, prematurity, abnormal fetal growth, spontaneous abortion, and congenital malformation [22]. Most of the current guidelines adopt glycosylated hemoglobin (HbA1c < 7.0% or 6.5% without hypoglycemia) to indicate a clinically safe point to satisfy pregnancy outcomes for women with DM or elevated blood glucose [23–25].…”

Section: Discussionmentioning

confidence: 99%

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Wei

¹

,

Xu

²

,

Yang

³

et al. 2019

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BackgroundDiabetes mellitus (DM) increases the risk of adverse maternal and neonatal outcomes, and optimization of glycemic control during pregnancy can help mitigate risks associated with diabetes. However, studies seldom focus precisely on maternal blood glucose level prior to pregnancy. We aimed to evaluate the associations between preconception blood fasting plasma glucose (FPG) level and subsequent pregnancy outcomes.Methods and findingsWe conducted a population-based retrospective cohort study among 6,447,339 women aged 20–49 years old who participated in National Free Pre-Pregnancy Checkups Project and completed pregnancy outcomes follow-up between 2010 and 2016 in China. During the preconception health examination, serum FPG concentration was measured, and self-reported history of DM was collected. Women were classified into three groups (normal FPG group: FPG < 5.6 mmol/L and no self-reported history of DM; impaired fasting glucose [IFG]: FPG 5.6–6.9 mmol/L and no self-reported history of DM; and DM: FPG ≥ 7.0 mmol/L or self-reported history of DM). The primary outcomes were adverse pregnancy outcomes, including spontaneous abortion, preterm birth (PTB), macrosomia, small for gestational age infant (SGA), birth defect, and perinatal infant death. Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (CI) after adjusting for confounding variables. The mean age of women was 25.24 years, 91.47% were of Han nationality, and 92.85% were from rural areas. The incidence of DM and IFG was 1.18% (76,297) and 13.15% (847,737), respectively. Only 917 (1.20%) women reported a history of DM (awareness of their DM status), of whom 37.28% (337) had an elevated preconception FPG level (≥ 5.6 mmol/L), regarded as noncontrolled DM. A total of 1,005,568 (15.60%) women had adverse pregnancy outcomes. Compared with women with normal FPG, women with IFG had higher risks of spontaneous abortion (OR 1.08; 95% CI 1.06–1.09; P < 0.001), PTB (1.02; 1.01–1.03; P < 0.001), macrosomia (1.07; 1.06–1.08; P < 0.001), SGA (1.06; 1.02–1.10; P = 0.007), and perinatal infant death (1.08; 1.03–1.12; P < 0.001); the corresponding ORs for women with DM were 1.11 (95% CI 1.07–1.15; P < 0.001), 1.17 (1.14–1.20; P < 0.001), 1.13 (1.09–1.16; P < 0.001), 1.17 (1.04–1.32; P = 0.008), and 1.59 (1.44–1.76; P < 0.001). Women with DM also had a higher risk of birth defect (OR 1.42; 95% CI 1.15–1.91; P = 0.002). Among women without self-reported history of DM, there was a positive linear association between FPG levels and spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death (P for trend <0.001, <0.001, <0.001, 0.001, <0.001). Information about hypoglycemic medication before or during pregnancy was not collected, and we cannot adjust it in the analysis, which could result in underestimation of risks. Data on 2-hour plasma glucose level and HbA1c concentration were not available, and the glycemic control status was evaluated according to FPG value in women with DM.ConclusionsWomen with preconception IF...

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“…Insulin requirements reduce dramatically in the immediate postpartum state and return to prepregnancy levels by 1 to 2 weeks postpartum. 6,7 Therefore, the patient must be appropriately educated that the insulin dosing will be significantly less. 5 Options related to family planning should be discussed prior to delivery so the patient may have the option of long-acting reversible contraception (LARC) placement at the time of delivery.…”

Section: Postpartum and Beyondmentioning

confidence: 99%

Diabetic gastroparesis  in pregnancy

Jones¹,

Kreider²

2021

WHC

0

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Pregestational Diabetes in Pregnancy

Cited by 30 publications

References 95 publications

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Diabetic gastroparesis  in pregnancy

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Pregestational Diabetes in Pregnancy

Cited by 30 publications

References 95 publications

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

Diabetic gastroparesis in pregnancy

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Product

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Diabetic gastroparesis  in pregnancy