Clinical outcomes of pregnancy in women with type 1 diabetes

Abstract

OBJECTIVE: To evaluate predictors of neonatal hypoglycemia and macrosomia in 107 consecutive pregnancies in type 1 diabetic women. METHODS: We conducted a case record analysis of singleton type 1 diabetic pregnancies between January 1994 and January 1999 following institution of standardized management. RESULTS: The duration of diabetes in the women was 12.9 ± 6.8 years, and 44 were primigravidas. The mean HbA1c throughout pregnancy was 7.2 ± 0.8%. There was no relationship between neonatal blood glucose (checked before the second feed) and HbA1c at any point in pregnancy or mean pregnancy HbA1c ( R = 0.20, P > .1). However, there was a negative correlation between neonatal blood glucose and maternal blood glucose during labor ( R = −0.33, P < .001). When maternal blood glucose during labor was greater than 8 mM (144 mg/dL), neonatal blood glucose was usually less than 2.5 mM (mean 1.7 ± 0.4 mM or 31 mg/dL). There was no relationship between mean HbA1c and birth weight ( R = 0.02, P > .1) or between maximum insulin dose and birth weight ( R = 0.09, P > .1). Fetal abdominal circumference measured by ultrasound at 34 weeks correlated strongly with birth weight ( R = 0.72, P < .001). CONCLUSION: Neonatal hypoglycemia correlates with maternal hyperglycemia in labor, not with HbA1c during pregnancy. Macrosomia does not correlate with HbA1c during pregnancy.