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Clinical Outcomes of Pregnancy in Women With Type 1 Diabetes

From the Departments of Medicine and Obstetrics, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.

Address reprint requests to: Roy Taylor, MD, Department of Medicine, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, United Kingdom; E-mail: roy.taylor{at}ncl.ac.uk.

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.

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				R. Taylor and J. M Davison Type 1 diabetes and pregnancy BMJ, April 7, 2007; 334(7596): 742 - 745. [Full Text] [PDF]

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