title: Longitudinal Patterns of Glycemic Control and Blood Pressure in Pregnant Women with Type 1 Diabetes Mellitus: Phenotypes from Functional Data Analysis.
abstract: ObjectiveTo identify phenotypes of type 1 diabetes control and associations with maternal/neonatal characteristics based on blood pressure (BP), glucose, and insulin curves during gestation, using a novel functional data analysis approach that accounts for sparse longitudinal patterns of medical monitoring during pregnancy.MethodsWe performed a retrospective longitudinal cohort study of women with type 1 diabetes whose BP, glucose, and insulin requirements were monitored throughout gestation as part of a program-project grant. Scores from sparse functional principal component analysis (fPCA) were used to classify gestational profiles according to the degree of control for each monitored measure. Phenotypes created using fPCA were compared with respect to maternal and neonatal characteristics and outcome.ResultsMost of the gestational profile variation in the monitored measures was explained by the first principal component (82-94%). Profiles clustered into three subgroups of high, moderate, or low heterogeneity, relative to the overall mean response. Phenotypes were associated with baseline characteristics, longitudinal changes in glycohemoglobin A1 and weight, and to pregnancy-related outcomes.ConclusionThree distinct longitudinal patterns of glucose, insulin, and BP control were found. By identifying these phenotypes, interventions can be targeted for subgroups at highest risk for compromised outcome, to optimize diabetes management during pregnancy.
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Rhonda D
authors.initials: RD
authors.lastname: Szczesniak
authors.affiliation: Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Leo L
authors.initials: LL
authors.lastname: Duan
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Mekibib
authors.initials: M
authors.lastname: Altaye
authors.affiliation: Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood*; D008137:Longitudinal Studies; D010641:Phenotype; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000503:physiopathology*; D025341:Principal Component Analysis / Q000379:methods; D012189:Retrospective Studies; D013599:Systole; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin