Top

Published in:

Open Access 01-07-2019 | Type 1 Diabetes | Article

Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

Authors: Karl Kristensen, Linda E. Ögge, Verena Sengpiel, Karin Kjölhede, Annika Dotevall, Anders Elfvin, Filip K. Knop, Nana Wiberg, Anastasia Katsarou, Nael Shaat, Lars Kristensen, Kerstin Berntorp

Published in: Diabetologia | Issue 7/2019

Abstract

Aims/hypothesis

The aim of this study was to analyse patterns of continuous glucose monitoring (CGM) data for associations with large for gestational age (LGA) infants and an adverse neonatal composite outcome (NCO) in pregnancies in women with type 1 diabetes.

Methods

This was an observational cohort study of 186 pregnant women with type 1 diabetes in Sweden. The interstitial glucose readings from 92 real-time (rt) CGM and 94 intermittently viewed (i) CGM devices were used to calculate mean glucose, SD, CV%, time spent in target range (3.5–7.8 mmol/l), mean amplitude of glucose excursions and also high and low blood glucose indices (HBGI and LBGI, respectively). Electronic records provided information on maternal demographics and neonatal outcomes. Associations between CGM indices and neonatal outcomes were analysed by stepwise logistic regression analysis adjusted for confounders.

Results

The number of infants born LGA was similar in rtCGM and iCGM users (52% vs 53%). In the combined group, elevated mean glucose levels in the second and the third trimester were significantly associated with LGA (OR 1.53, 95% CI 1.12, 2.08, and OR 1.57, 95% CI 1.12, 2.19, respectively). Furthermore, a high percentage of time in target in the second and the third trimester was associated with lower risk of LGA (OR 0.96, 95% CI 0.94, 0.99 and OR 0.97, 95% CI 0.95, 1.00, respectively). The same associations were found for mean glucose and for time in target and the risk of NCO in all trimesters. SD was significantly associated with LGA in the second trimester and with NCO in the third trimester. Glucose patterns did not differ between rtCGM and iCGM users except that rtCGM users had lower LBGI and spent less time below target.

Conclusions/interpretation

Higher mean glucose levels, higher SD and less time in target range were associated with increased risk of LGA and NCO. Despite the use of CGM throughout pregnancy, the day-to-day glucose control was not optimal and the incidence of LGA remained high.

Available only for authorised users

Persson M, Pasupathy D, Hanson U, Norman M (2011) Birth size distribution in 3,705 infants born to mothers with type 1 diabetes: a population-based study. Diabetes Care 34(5):1145–1149. https://doi.org/10.2337/dc10-2406 CrossRefPubMedPubMedCentral

Evers IM, de Valk HW, Mol BW, ter Braak EW, Visser GH (2002) Macrosomia despite good glycaemic control in type I diabetic pregnancy; results of a nationwide study in the Netherlands. Diabetologia 45:1484–1489CrossRef

Jensen DM, Damm P, Moelsted-Pedersen L et al (2004) Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care 27(12):2819–2823. https://doi.org/10.2337/diacare.27.12.2819 CrossRefPubMed

Persson M, Pasupathy D, Hanson U, Norman M (2012) Disproportionate body composition and perinatal outcome in large-for-gestational-age infants to mothers with type 1 diabetes. BJOG 119(5):565–572. https://doi.org/10.1111/j.1471-0528.2012.03277.x CrossRefPubMed

Clausen TD, Mathiesen ER, Hansen T et al (2008) High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care 31(2):340–346. https://doi.org/10.2337/dc07-1596 CrossRefPubMed

Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ (2007) Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 30(9):2287–2292. https://doi.org/10.2337/dc06-2361 CrossRefPubMed

Manderson JG, Mullan B, Patterson CC, Hadden DR, Traub AI, McCance DR (2002) Cardiovascular and metabolic abnormalities in the offspring of diabetic pregnancy. Diabetologia 45(7):991–996. https://doi.org/10.1007/s00125-002-0865-y CrossRefPubMed

Rijpert M, Evers IM, de Vroede MA, de Valk HW, Heijnen CJ, Visser GH (2009) Risk factors for childhood overweight in offspring of type 1 diabetic women with adequate glycemic control during pregnancy: nationwide follow-up study in the Netherlands. Diabetes Care 32(11):2099–2104. https://doi.org/10.2337/dc09-0652 CrossRefPubMedPubMedCentral

Pedersen J (1954) Weight and length at birth of infants of diabetic mothers. Acta Endocrinol 16(4):330–342. https://doi.org/10.1530/acta.0.0160330 CrossRefPubMed

10.

Jovanovic-Peterson L, Peterson CM, Reed GF et al (1991) Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study. Am J Obstet Gynecol 164:103–111CrossRef

11.

Herranz L, Pallardo LF, Hillman N, Martin-Vaquero P, Villarroel A, Fernandez A (2007) Maternal third trimester hyperglycaemic excursions predict large-for-gestational-age infants in type 1 diabetic pregnancy. Diabetes Res Clin Pract 75(1):42–46. https://doi.org/10.1016/j.diabres.2006.05.019 CrossRefPubMed

12.

Kerssen A, de Valk HW, Visser GH (2007) Increased second trimester maternal glucose levels are related to extremely large-for-gestational-age infants in women with type 1 diabetes. Diabetes Care 30(5):1069–1074. https://doi.org/10.2337/dc06-1985 CrossRefPubMed

13.

Garcia-Patterson A, Gich I, Amini SB, Catalano PM, de Leiva A, Corcoy R (2010) Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction. Diabetologia 53(3):446–451. https://doi.org/10.1007/s00125-009-1633-z CrossRefPubMed

14.

Goudie RJ, Lunn D, Hovorka R, Murphy HR (2014) Pharmacokinetics of insulin aspart in pregnant women with type 1 diabetes: every day is different. Diabetes Care 37(6):e121–e122. https://doi.org/10.2337/dc13-2535 CrossRefPubMed

15.

Murphy HR, Bell R, Cartwright C et al (2017) Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia 60(9):1668–1677. https://doi.org/10.1007/s00125-017-4314-3 CrossRefPubMedPubMedCentral

16.

Murphy HR, Rayman G, Lewis K et al (2008) Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 337:a1680. https://doi.org/10.1136/bmj.a1680 CrossRef

17.

Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER (2013) The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care 36(7):1877–1883. https://doi.org/10.2337/dc12-2360 CrossRefPubMedPubMedCentral

18.

Law GR, Ellison GT, Secher AL et al (2015) Analysis of continuous glucose monitoring in pregnant women with diabetes: distinct temporal patterns of glucose associated with large-for-gestational-age infants. Diabetes Care 38(7):1319–1325. https://doi.org/10.2337/dc15-0070 CrossRefPubMed

19.

Gupta R, Khoury J, Altaye M, Dolan L, Szczesniak RD (2017) Glycemic excursions in type 1 diabetes in pregnancy: a semiparametric statistical approach to identify sensitive time points during gestation. J Diabetes Res 2017:2852913CrossRef

20.

McGrath RT, Glastras SJ, Seeho SK, Scott ES, Fulcher GR, Hocking SL (2017) Association between glycemic variability, HbA1c, and large-for-gestational-age neonates in women with type 1 diabetes. Diabetes Care 40(8):e98–e100. https://doi.org/10.2337/dc17-0626 CrossRefPubMed

21.

Feig DS, Donovan LE, Corcoy R et al (2017) Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 390(10110):2347–2359. https://doi.org/10.1016/S0140-6736(17)32400-5 CrossRefPubMedPubMedCentral

22.

Danne T, Nimri R, Battelino T et al (2017) International consensus on use of continuous glucose monitoring. Diabetes Care 40(12):1631–1640. https://doi.org/10.2337/dc17-1600 CrossRefPubMedPubMedCentral

23.

Service FJ, O’Brien PC, Rizza RA (1987) Measurements of glucose control. Diabetes Care 10(2):225–237. https://doi.org/10.2337/diacare.10.2.225 CrossRefPubMed

24.

Kovatchev BP, Cox DJ, Gonder-Frederick LA, Clarke W (1997) Symmetrization of the blood glucose measurement scale and its applications. Diabetes Care 20(11):1655–1658. https://doi.org/10.2337/diacare.20.11.1655 CrossRefPubMed

25.

Baghurst PA (2011) Calculating the mean amplitude of glycemic excursion from continuous glucose monitoring data: an automated algorithm. Diabetes Technol Ther 13(3):296–302. https://doi.org/10.1089/dia.2010.0090 CrossRefPubMed

26.

Baghurst PA, Rodbard D, Cameron FJ (2010) The minimum frequency of glucose measurements from which glycemic variation can be consistently assessed. J Diabetes Sci Technol 4(6):1382–1385. https://doi.org/10.1177/193229681000400612 CrossRefPubMedPubMedCentral

27.

Fabris C, Patek SD, Breton MD (2015) Are risk indices derived from CGM interchangeable with SMBG-based indices? J Diabetes Sci Technol 10:50–59CrossRef

28.

Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B (1996) Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr 85(7):843–848. https://doi.org/10.1111/j.1651-2227.1996.tb14164.x CrossRefPubMed

29.

Ananth CV, Schisterman EF (2017) Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics. Am J Obstet Gynecol 217(2):167–175. https://doi.org/10.1016/j.ajog.2017.04.016 CrossRefPubMedPubMedCentral

30.

Murphy HR, Rayman G, Duffield K et al (2007) Changes in the glycemic profiles of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care 30(11):2785–2791. https://doi.org/10.2337/dc07-0500 CrossRefPubMed

31.

Stewart ZA, Wilinska ME, Hartnell S et al (2016) Closed-loop insulin delivery during pregnancy in women with type 1 diabetes. NEJM 375(7):644–654. https://doi.org/10.1056/NEJMoa1602494 CrossRefPubMed

32.

Stewart ZA, Wilinska ME, Hartnell S et al (2018) Day-and-night closed-loop insulin delivery in a broad population of pregnant women with type 1 diabetes: a randomized controlled crossover trial. Diabetes Care 41(7):1391–1399. https://doi.org/10.2337/dc17-2534 CrossRefPubMed

33.

Carlsson BM, Andersson PN, Alnervik J, Carstensen J, Lind M (2012) Availability of insulin pump therapy in clinical practice. Diabet Med 29(8):1055–1059. https://doi.org/10.1111/j.1464-5491.2011.03517.x CrossRefPubMed

34.

Glinianaia SV, Tennant PW, Bilous RW, Rankin J, Bell R (2012) HbA_1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study. Diabetologia 55(12):3193–3203. https://doi.org/10.1007/s00125-012-2721-z CrossRefPubMed

35.

Murphy HR, Steel SA, Roland JM et al (2011) Obstetric and perinatal outcomes in pregnancies complicated by type 1 and type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med 28(9):1060–1067. https://doi.org/10.1111/j.1464-5491.2011.03333.x CrossRefPubMedPubMedCentral

36.

Ladfors L, Shaat N, Wiberg N, Katasarou A, Berntorp K, Kristensen K (2017) Fetal overgrowth in women with type 1 and type 2 diabetes mellitus. PLoS One 12(11):e0187917. https://doi.org/10.1371/journal.pone.0187917 CrossRefPubMedPubMedCentral

37.

Desoye G, Nolan CJ (2016) The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia 59(6):1089–1094. https://doi.org/10.1007/s00125-016-3931-6 CrossRefPubMedPubMedCentral

38.

Dalfra MG, Sartore G, Di Cianni G et al (2011) Glucose variability in diabetic pregnancy. Diabetes Technol Ther 13(8):853–859. https://doi.org/10.1089/dia.2010.0145 CrossRefPubMed

39.

Mulla BM, Noor N, James-Todd T et al (2018) Continuous glucose monitoring, glycemic variability, and excessive fetal growth in pregnancies complicated by type 1 diabetes. Diabetes Technol Ther 20(6):413–419. https://doi.org/10.1089/dia.2017.0443 CrossRefPubMedPubMedCentral

40.

Lindell G, Marsal K, Kallen K (2012) Impact of maternal characteristics on fetal growth in the third trimester: a population-based study. Ultrasound Obstet Gynecol 40(6):680–687. https://doi.org/10.1002/uog.11125 CrossRefPubMed

41.

Scott EM, Bilous RW, Kautzky-Willer A (2018) Accuracy, user acceptability, and safety evaluation for the freestyle libre flash glucose monitoring system when used by pregnant women with diabetes. Diabetes Technol Ther 20(3):180–188. https://doi.org/10.1089/dia.2017.0386 CrossRefPubMedPubMedCentral

42.

Leelarathna L, Wilmot EG (2018) Flash forward: a review of flash glucose monitoring. Diabet Med 35(4):472–482. https://doi.org/10.1111/dme.13584 CrossRefPubMed

Title: Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies
Authors: Karl Kristensen
Linda E. Ögge
Verena Sengpiel
Karin Kjölhede
Annika Dotevall
Anders Elfvin
Filip K. Knop
Nana Wiberg
Anastasia Katsarou
Nael Shaat
Lars Kristensen
Kerstin Berntorp
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Keyword: Type 1 Diabetes
Published in: Diabetologia / Issue 7/2019
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-4850-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 7/2019

Human gut microbiota transferred to germ-free NOD mice modulate the progression towards type 1 diabetes regardless of the pace of beta cell function loss in the donor

Perinatal risk factors for type 1 diabetes revisited: a population-based register study

Correction to: Bone marrow pericyte dysfunction in individuals with type 2 diabetes

Type 2 diabetes: a multifaceted disease

Trends in overall, cardiovascular and cancer-related mortality among individuals with diabetes reported on death certificates in the United States between 2007 and 2017

Soluble receptor for AGE in diabetic nephropathy and its progression in Finnish individuals with type 1 diabetes

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page