title: Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester.
abstract: OBJECTIVE
  To analyse data from a randomised, controlled study of prandial insulin aspart versus human insulin, both with NPH insulin, in pregnant women with type 1 diabetes for potential factors predicting poor pregnancy outcomes. RESEARCH DESIGN/METHOD: Post hoc analysis including 91 subjects randomised prior to pregnancy with known outcome in early pregnancy and 259 subjects randomised prior to pregnancy/during pregnancy of <10 weeks' gestation with known late-pregnancy outcomes. Poor early-pregnancy outcomes included fetal loss <22 gestational weeks and/or congenital malformation (n=18). Poor late-pregnancy outcomes included: composite endpoint including pre-eclampsia, preterm delivery and perinatal death (n=78); preterm delivery (n=63); and excessive fetal growth (n=88).
  
  
  RESULTS
  18 patients experienced a malformed/lost fetus in early pregnancy - none preceded by severe hypoglycaemia. Albuminuria in early pregnancy was a significant predictor of poor late-pregnancy outcome (composite endpoint; p=0.012). In the third trimester, elevated HbA1c, ≥ 1 plasma glucose (PG) measurement >11 mmol/L (198 mg/dL) and %PG values outside 3.9-7.0 mmol/L (70-126 mg/dL) were significant predictors of poor late-pregnancy outcomes (all p<0.05).
  
  
  CONCLUSIONS
  Elevated HbA1c, high glucose spikes and out-of-range %PG in the third trimester, and albuminuria in early pregnancy, are associated with poor late-pregnancy outcomes.
authors.affiliation: Departments of Endocrinology and Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen , Copenhagen , Denmark .
authors.forename: Peter
authors.initials: P
authors.lastname: Damm
authors.forename: Henriette
authors.initials: H
authors.lastname: Mersebach
authors.forename: Jacob
authors.initials: J
authors.lastname: Råstam
authors.forename: Risto
authors.initials: R
authors.lastname: Kaaja
authors.forename: Moshe
authors.initials: M
authors.lastname: Hod
authors.forename: David R
authors.initials: DR
authors.lastname: McCance
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: Mathiesen
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications; D001786:Blood Glucose / Q000032:analysis*; D000013:Congenital Abnormalities / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005502:Food; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D061267:Insulin Aspart / Q000008:administration & dosage; D007336:Insulin, Isophane / Q000008:administration & dosage; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011254:Pregnancy in Diabetics / Q000097:blood*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D061267:Insulin Aspart; D007336:Insulin, Isophane