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Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes.
MedLine Citation:
PMID:  25368104     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To assess the relationship between second and third trimester glycemic control and adverse outcomes in pregnant women with type 1 diabetes, as uncertainty exists about optimum glycemic targets.
RESEARCH DESIGN AND METHODS: Pregnancy outcomes were assessed prospectively in 725 women with Type 1 diabetes from the Diabetes and Pre-eclampsia Intervention Trial. HbA1c (A1C) values at 26 and 34 weeks' gestation were categorised into 5 groups; the lowest, <6.0% (42mmol/mol), being the reference. Average pre- and post-prandial results from an eight-point capillary glucose profile the previous day were categorised into 5 groups; the lowest (pre-prandial <5.0mmol/l, post-prandial <6.0mmol/l) being the reference.
RESULTS: An A1C of 6.0-6.4% (42-47mmol/mol) at 26 weeks' gestation was associated with a significantly increased risk of large for gestational age (LGA)(odds ratio 1.7 [95% CI 1.0-3.0]) and an A1C of 6.5-6.9% (48-52mmol/mol) with a significantly increased risk of pre-term delivery (odds ratio 2.5 [95% CI 1.3-4.8]), pre-eclampsia (4.3 [1.7-10.8]), need for a neonatal glucose infusion (2.9 [1.5-5.6]) and a composite adverse outcome (3.2 [1.3-8.0]). These risks increased progressively with increasing A1C. Results were similar at 34 weeks' gestation. Glucose data showed less consistent trends, although. the risk of a composite adverse outcome increased with pre-prandial glucose levels between 6.0-6.9mmol/l at 34 weeks (3.3[1.3-8.0]).
CONCLUSIONS: LGA increased significantly with an A1C ≥6.0 (42mmol/mol) at 26 and at 34 weeks gestation and with other adverse outcomes with an A1C≥ 6.5% (48mmol/mol). The data suggest that there is clinical utility in regular measurement of A1C during pregnancy.
Michael J A Maresh; Valerie A Holmes; Christopher C Patterson; Ian S Young; Donald W M Pearson; James D Walker; David R McCance;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-3
Journal Detail:
Title:  Diabetes care     Volume:  -     ISSN:  1935-5548     ISO Abbreviation:  Diabetes Care     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-4     Completed Date:  -     Revised Date:  2014-11-5    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
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