title: Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control.
abstract: Macrosomia risk remains high in type 1 diabetes (T1DM) complicated pregnancies. A linear relationship between macrosomia risk and glycated hemoglobin A1c(HbA1c) was described; however, low range of HbA1chas not been studied. We aimed to identify risk factors and examine the impact of HbA1con the occurrence of macrosomia in newborns of T1DM women from a cohort with good glycemic control. In this observational retrospective one-center study we analyzed records of 510 consecutive T1DM pregnancies (1998-2012). The analyzed group consisted of 375 term singleton pregnancies. We used multiple regression models to examine the impact of HbA1cand self-monitored glucose in each trimester on the risk of macrosomia and birth weight. The median age of T1DM women was 28 years, median T1DM duration-11 years, median pregestational BMI-23.3 kg/m2. Median birth weight reached 3520 g (1st and 3rd quartiles 3150 and 3960, respectively) at median 39 weeks of gestation. There were 85 (22.7 %) macrosomic (>4000 g) newborns. Median HbA1clevels in the 1st, 2nd, and 3rd trimester were 6.4, 5.7, and 5.6 %. Third trimester HbA1c, mean fasting self-monitored glucose and maternal age were independent predictors of birth weight and macrosomia. There was a linear relationship between 3rd trimester HbA1cand macrosomia risk in HbA1crange from 4.5 to 7.0 %. Macrosomia in children of T1DM mothers was common despite excellent metabolic control. Glycemia during the 3rd trimester was predominantly responsible for this condition.
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Cyganek
authors.affiliation: Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Skupien
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.|Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Katra
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.|Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Hebda-Szydlo
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.
authors.forename: Izabela
authors.initials: I
authors.lastname: Janas
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.|Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Trznadel-Morawska
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.|Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Witek
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland.|Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Kozek
authors.affiliation: Department of Metabolic Diseases, University Hospital, Krakow, Poland. malecki_malecki@yahoo.com.|Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland. malecki_malecki@yahoo.com.
authors.forename: Maciej T
authors.initials: MT
authors.lastname: Malecki
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: Glycated hemoglobin A1c; Macrosomia; Pregnancy; Type 1 diabetes