Abstract
Aim. To examine the gestational glycemic profile and identify specific times during pregnancy that variability in glucose levels, measured by change in velocity and acceleration/deceleration of blood glucose fluctuations, is associated with delivery of a large-for-gestational-age (LGA) baby, in women with type 1 diabetes. Methods. Retrospective analysis of capillary blood glucose levels measured multiple times daily throughout gestation in women with type 1 diabetes was performed using semiparametric mixed models. Results. Velocity and acceleration/deceleration in glucose levels varied across gestation regardless of delivery outcome. Compared to women delivering LGA babies, those delivering babies appropriate for gestational age exhibited significantly smaller rates of change and less variation in glucose levels between 180 days of gestation and birth. Conclusions. Use of innovative statistical methods enabled detection of gestational intervals in which blood glucose fluctuation parameters might influence the likelihood of delivering LGA baby in mothers with type 1 diabetes. Understanding dynamics and being able to visualize gestational changes in blood glucose are a potentially useful tool to assist care providers in determining the optimal timing to initiate continuous glucose monitoring.
Highlights
Pregnancy in women with type 1 diabetes mellitus is associated with an increased risk of various adverse outcomes— both for mothers and for their offspring
This shows the effect of maternal glucose transported across the placenta emphasizing the importance of fluctuations in maternal glucose levels, which we have termed as velocity and acceleration/deceleration, on fetal insulin secretion
Using a novel statistical approach, we have demonstrated that time-specific fluctuations in velocity and acceleration/deceleration of glucose levels differed across gestational age and between women delivering LGA and AGA infants
Summary
Pregnancy in women with type 1 diabetes mellitus is associated with an increased risk of various adverse outcomes— both for mothers and for their offspring. These morbidities include preeclampsia, preterm delivery, cesarean section delivery, and large-for-gestational-age (LGA) infant [1, 2]. Management of pregnant women with diabetes focuses on the importance of good glycemic control before and during pregnancy, to decrease the frequency of adverse outcomes for both infants and mothers [6, 7]. Tracking maternal glycemic control over the entire pregnancy has provided insights into the effects of maternal glucose control on various neonatal outcomes, including LGA babies [8].
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