Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Shows that Fetal Heart Rate Correlates with Maternal Glycemia.
BACKGROUND
Much evidence has shown that pregnancies in women with preexisting diabetes are affected by an increased risk of maternal and fetal adverse outcomes, probably linked to poor glycemic control. Despite great progress in medical care, the rate of stillbirths remains much higher in diabetes patients than in the general population. Recent technological advances in the field of glucose monitoring and noninvasive fetal heart rate monitoring made it possible to observe the fetal-maternal dependencies in a continuous manner.


METHODS
Fourteen type 1 diabetes patients were involved into the study and fitted with a blinded continuous glucose monitoring (CGM) recorder. Fetal electrocardiogram data were recorded using the Monica AN24™ device (Monica Healthcare Ltd., Nottingham, United Kingdom), the recordings of which were matched with CGM data. Statistical analysis was performed using a generalized mixed-effect logistic regression to account for individual factors.


RESULTS
The mean number of paired data points per patient was 254±106, representing an observation period of 21.2±8.8 h. Mean glycemia equaled 5.64±0.68 mmol/L, and mean fetal heart rate was 135±6 beats/min. Higher glycemia correlated with fetal heart rate (R=0.32; P<0.0001) and was associated with higher odds of the fetus developing small accelerations (odds ratio=1.05; 95% confidence interval, 1.00-1.10; P=0.04).


CONCLUSIONS
Elevated maternal glycemia of mothers with diabetes is associated with accelerations of fetal heart rate.
1 Department of Diabetology and Metabolic Diseases, Medical University of Lodz , Poland .
Katarzyna
K
Cypryk
1 Department of Diabetology and Metabolic Diseases, Medical University of Lodz , Poland .
Lukasz
L
Bartyzel
1 Department of Diabetology and Metabolic Diseases, Medical University of Lodz , Poland .
Monika
M
Zurawska-Klis
2 Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz , Poland .
Wojciech
W
Mlynarski
2 Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz , Poland .
Agnieszka
A
Szadkowska
3 Feto-Maternal and Gynecology Department, Research Institute, Polish Mother's Memorial Hospital , Lodz, Poland .
Jan
J
Wilczynski
3 Feto-Maternal and Gynecology Department, Research Institute, Polish Mother's Memorial Hospital , Lodz, Poland .
Dorota
D
Nowakowska
4 Department of Structural Biology, Faculty of Biomedical Sciences and Postgraduate Education, Medical University of Lodz , Lodz, Poland .
Lucyna A
LA
Wozniak
2 Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz , Poland .
Wojciech
W
Fendler
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000706:statistics & numerical data*; D015148:Cardiotocography / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*
D001786:Blood Glucose