Law, GR, Alnaji, A, Alrefaii, L et al. (6 more authors) (2019) Suboptimal Nocturnal Glucose Control Is Associated With Large for Gestational Age in Treated Gestational Diabetes Mellitus. Diabetes Care, 42 (5). pp. 810-815. ISSN 0149-5992
Abstract
Objective:
Continuous glucose monitoring (CGM) provides far greater detail about fetal exposure to maternal glucose across the 24 hour day. Our aim was to examine the role of temporal glucose variation on the development of large for gestational age infants (LGA) in women with treated gestational diabetes (GDM).
Research Design and Methods:
A prospective observational study of 162 pregnant women with GDM in specialist multidisciplinary antenatal diabetes clinics. Participants undertook a 7-day masked CGM at 30-32 weeks gestation. Standard summary indices and glycemic variability measures of CGM were calculated. Functional data analysis was applied to determine differences in temporal glucose profiles. LGA was defined as birth weight ≥90th percentile adjusted for infant sex, gestational age, maternal BMI, ethnicity and parity.
Results:
Mean glucose was significantly higher in women who delivered an LGA infant (6.2 vs 5.8 mmol/l P=0.025 or 111.6 mg/dl vs 104.4 mg/dl respectively). There were no significant differences in percentage time in, above or below the target glucose range, or in glucose variability measures (all P>0.05). Functional data analysis revealed that the higher mean glucose was driven by a significantly higher glucose for 6 hours overnight (00h30-06h30) in mothers of LGA infants (6.0 ± 1.0 mmol/l vs 5.5 ± 0.8 mmol/l p=0.005; 108.0 ± 18.0 mg/dl vs 99.0 ± 14.4 mg/dl respectively).
Conclusions:
Mothers of LGA infants run significantly higher glucose overnight compared to mothers without LGA. Detecting and addressing nocturnal glucose control may help to further reduce rates of LGA in women with GDM.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2019 by the American Diabetes Association. This is an author produced version of a paper published in Diabetes Care. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Diabetes, pregnancy, macrosomia, glucose, Continuous Glucose Monitoring, functional data analysis, circadian, diurnal, birthweight, temporal. |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 08 Feb 2019 09:56 |
Last Modified: | 15 Jun 2019 05:56 |
Status: | Published |
Publisher: | American Diabetes Association |
Identification Number: | 10.2337/dc18-2212 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:142293 |