Abstract
BackgroundOffspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).MethodsThis was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres (ClinicalTrials.gov NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome.ResultsAccelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62, 67 and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2, 1.3 and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born > 97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes.ConclusionsGROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.Trial registrationThis trial is registered with ClinicalTrials.gov. number NCT01788527. Trial registered 11/2/2013.
Highlights
Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity
Two hundred twenty-five women and infants were included in this analysis, including 200 from the pregnancy arm and 25 from the pre-pregnancy arm who became pregnant during the trial
large- and small-for-gestational age (LGA) according to GROW, INTERGROWTH and World Health Organisation (WHO) criteria was associated with increased risks of perinatal complications (Table 2)
Summary
Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). Infants who are small- or large-forgestational-age (SGA or LGA; birth weight < 10th or >90th percentile) experience higher risks of morbidity and mortality [3, 4]. Recent population based data suggests that despite improvements in care, infants of women with type 1 diabetes (T1D) remain at high risk of LGA (rates ~ 50%) [5]. LGA rates were high in the CONCEPTT international randomized controlled trial of the use of continuous glucose monitoring (CGM) in comparison with capillary blood glucose monitoring in pregnant women with T1D [6]. Advocates suggest that customised centiles reduce over-investigation of normal fetuses and can more accurately predict fetuses at increased risk of stillbirth and perinatal mortality [9, 10]
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