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Gong Y, Liu Y, Wang J, Wei T, Yan J, Yang D, Zheng X, Weng J, Luo S. Health-related quality of life in pregnant women with type 1 diabetes and associations with maternal and neonatal complications. Qual Life Res 2024:10.1007/s11136-024-03716-x. [PMID: 38888675 DOI: 10.1007/s11136-024-03716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Preexisting type 1 diabetes is a stressful situation for women in pregnancy. We aimed to evaluate health-related quality of life (HRQoL) during pregnancy in women with type 1 diabetes and examine the association between HRQoL and pregnancy outcomes. METHODS This multicenter prospective cohort study involved 115 pregnant women with type 1 diabetes from 11 participating centers in China. HRQoL was investigated in three trimesters using European Quality-of-life 5-Dimension 5-Level questionnaire (EQ-5D-5 L). Chinese time trade-off value method was used to calculate the EQ-5D-5 L score. Multivariable logistic regression model was used to evaluate the effect of HRQoL on maternal and neonatal outcomes. Receiver operating characteristic curves and distribution-based methods were employed to estimate minimally important differences of clinically important decline in HRQoL. RESULTS 50.43% of the studied women with type 1 diabetes reported impaired HRQoL in pregnancy. Estimated maternal HRQoL significantly decreased from early to mid-pregnancy (mean EQ-5D-5 L score 0.97 in the first trimester and 0.91 in the second trimester) and improved slightly in late pregnancy (mean EQ-5D-5 L score 0.95). Multivariable regression model showed that women who experienced impaired HRQoL in pregnancy had higher risk of hypertensive disorder, preterm birth, and composite pregnancy outcome. The estimated minimally important difference for composite pregnancy outcome was -0.045 to -0.043. CONCLUSIONS Experiencing impaired HRQoL during pregnancy was associated with a higher risk of hypertensive disorder and preterm birth in women with type 1 diabetes. The estimated minimally important difference of EQ-5D-5 L might serve as a clinically important tool in prenatal care. TRIAL REGISTRATION No.ChiCTR1900025955.
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Affiliation(s)
- Yixin Gong
- School of Medicine, Southeast University, Nanjing, China
- Department of Cardiology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yujie Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Jing Wang
- School of Medicine, Southeast University, Nanjing, China
| | - Tian Wei
- Department of Cardiology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueying Zheng
- School of Medicine, Southeast University, Nanjing, China
| | - Jianping Weng
- School of Medicine, Southeast University, Nanjing, China
- Department of Cardiology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Sihui Luo
- Department of Cardiology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
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Venkatesh KK, Huang X, Cameron NA, Petito LC, Joseph J, Landon MB, Grobman WA, Khan SS. Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12 million pregnancies. BJOG 2024; 131:26-35. [PMID: 37366023 PMCID: PMC10751384 DOI: 10.1111/1471-0528.17587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/24/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural-urban disparities in adverse pregnancy outcomes. DESIGN Serial, cross-sectional analysis. SETTING US National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019. POPULATION A total of 12 401 888 singleton live births to nulliparous women aged 15-44 years. METHODS We calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age-adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban-Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification). MAIN OUTCOME MEASURES The outcomes (modelled separately) were diagnoses of DM and GDM. RESULTS From 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%-3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%-3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%-4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%-4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%-1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%-1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural-urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural-urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all). CONCLUSIONS The frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural-urban disparities existed for DM and GDM, and increased over time for GDM. These rural-urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.
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Affiliation(s)
- Kartik K. Venkatesh
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Xiaoning Huang
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Natalie A. Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics (Chicago, IL)
| | - Lucia C. Petito
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Joshua Joseph
- The Ohio State University College of Medicine, Department of Medicine (Columbus, OH)
| | - Mark B. Landon
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - William A. Grobman
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Sadiya S. Khan
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology (Chicago, IL)
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Rademaker D, van der Wel AWT, van Eekelen R, Voormolen DN, de Valk HW, Evers IM, Mol BW, Franx A, Siegelaar SE, van Rijn BB, DeVries JH, Painter RC. Continuous glucose monitoring metrics and pregnancy outcomes in insulin-treated diabetes: A post-hoc analysis of the GlucoMOMS trial. Diabetes Obes Metab 2023; 25:3798-3806. [PMID: 37735847 DOI: 10.1111/dom.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
AIM To investigate the association between continuous glucose monitoring (CGM) metrics and perinatal outcomes in insulin-treated diabetes mellitus in pregnancy. MATERIALS AND METHODS In a post-hoc analysis of the GlucoMOMS randomized controlled trial, we investigated the association between the metrics of an offline, intermittent CGM, glycated haemoglobin (HbA1c) and perinatal outcomes per trimester in different types of diabetes (type 1, 2 or insulin-treated gestational diabetes mellitus [GDM]). Data were analysed using multivariable binary logistic regression. Outcomes of interest were neonatal hypoglycaemia, pre-eclampsia, preterm birth, large for gestational age (LGA) and Neonatal Intensive Care Unit (NICU) admission. The glucose target range was defined as 3.5-7.8 mmol/L (63-140 mg/dL). RESULTS Of the 147 participants (N = 50 type 1 diabetes, N = 94 type 2 diabetes/insulin-treated GDM) randomized to the CGM group of the GlucoMOMS trial, 115 participants had CGM metrics available and were included in the current study. We found that, in pregnancies with type 1 diabetes, a higher second trimester mean glucose was associated with LGA (odds ratio 2.6 [95% confidence interval 1.1-6.2]). In type 2 and insulin-treated gestational diabetes, an increased area under the curve above limit was associated with LGA (odds ratio 10.0 [95% confidence interval 1.4-72.8]). None of the CGM metrics were associated with neonatal hypoglycaemia, pre-eclampsia, shoulder dystocia, preterm birth and NICU admission rates for pregnancies complicated by any type of diabetes. CONCLUSION In this study, in type 2 diabetes or insulin-treated GDM, the glucose increased area under the curve above limit was associated with increased LGA. In type 1 diabetes, the mean glucose was the major determinant of LGA. Our study found no evidence that other CGM metrics determined adverse pregnancy outcomes.
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Affiliation(s)
- Doortje Rademaker
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Anne W T van der Wel
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands
| | - Rik van Eekelen
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands
| | | | - Harold W de Valk
- Department of Endocrinology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Inge M Evers
- Department of Obstetrics and Gynecology, Amersfoort, The Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Abderdeen, UK
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus University, Rotterdam, The Netherlands
| | - Sarah E Siegelaar
- Amsterdam UMC location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Gynecology, Erasmus University, Rotterdam, The Netherlands
| | - J Hans DeVries
- Amsterdam UMC location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands
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Lee SI, Hanley S, Vowles Z, Plachcinski R, Moss N, Singh M, Gale C, Fagbamigbe AF, Azcoaga-Lorenzo A, Subramanian A, Taylor B, Nelson-Piercy C, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Dolk H, Hope H, Phillips K, Abel KM, Eastwood KA, Kent L, Locock L, Loane M, Mhereeg M, Brocklehurst P, McCann S, Brophy S, Wambua S, Hemali Sudasinghe SPB, Thangaratinam S, Nirantharakumar K, Black M. The development of a core outcome set for studies of pregnant women with multimorbidity. BMC Med 2023; 21:314. [PMID: 37605204 PMCID: PMC10441728 DOI: 10.1186/s12916-023-03013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity. METHODS We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations. RESULTS Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs. CONCLUSIONS Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephanie Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Ngawai Moss
- Patient and public representative, London, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Hospital Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
| | | | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- Center for Epidemiology and Research in Population Health (CERPOP), INSERM, Toulouse, France
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Ulster University, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Louise Locock
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- The Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Mohamed Mhereeg
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sharon McCann
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Closed-loop insulin delivery in pregnant women with type 1 diabetes (CRISTAL): a multicentre randomized controlled trial - study protocol. BMC Pregnancy Childbirth 2023; 23:180. [PMID: 36927458 PMCID: PMC10018977 DOI: 10.1186/s12884-023-05481-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Despite increasing use of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII, insulin pumps) in type 1 diabetes (T1D) in pregnancy, achieving recommended pregnancy glycaemic targets (3.5-7.8 mmol/L or 63-140 mg/dL) remains challenging. Consequently, the risk of adverse pregnancy outcomes remains high. Outside pregnancy, hybrid closed-loop (HCL) insulin delivery systems have led to a paradigm shift in the management of T1D, with 12% higher time in glucose target range (TIR) compared to conventional CSII. However, most commercially available HCL systems are currently not approved for use in pregnancy. This study aims to evaluate the efficacy, safety and cost-effectiveness of the MiniMed™ 780G HCL system (Medtronic) in T1D in pregnancy. METHODS In this international, open-label, randomized controlled trial (RCT), we will compare the MiniMed™ 780G HCL system to standard of care (SoC) in T1D in pregnancy. Women aged 18-45 years with T1D diagnosis of at least one year, HbA1c ≤ 86 mmol/mol (≤ 10%), and confirmed singleton pregnancy up to 11 weeks 6 days will be eligible. After providing written informed consent, all participants will wear a similar CGM system (Guardian™ 3 or Guardian™ 4 CGM) during a 10-day run-in phase. After the run-in phase, participants will be randomised 1:1 to 780G HCL (intervention) or SoC [control, continuation of current T1D treatment with multiple daily injections (MDI) or CSII and any type of CGM] stratified according to centre, baseline HbA1c (< 53 vs. ≥ 53 mmol/mol or < 7 vs. ≥ 7%), and method of insulin delivery (MDI or CSII). The primary outcome will be the time spent within the pregnancy glucose target range, as measured by the CGM at four time points in pregnancy: 14-17, 20-23, 26-29, and 33-36 weeks. Prespecified secondary outcomes will be overnight TIR, time below range (TBR: <3.5 mmol/L or < 63 mg/dL), and overnight TBR. Other outcomes will be exploratory. The planned sample size is 92 participants. The study will end after postpartum discharge from hospital. Analyses will be performed according to intention-to-treat as well as per protocol. DISCUSSION This large RCT will evaluate a widely used commercially available HCL system in T1D in pregnancy. Recruitment began in January 2021 and was completed in October 2022. Study completion is expected in May 2023. TRIAL REGISTRATION ClinicalTrials.gov: NCT04520971. Registration date: August 20, 2020. https://clinicaltrials.gov/ct2/show/NCT04520971.
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Dhanasekaran M, Mohan S, Erickson D, Shah P, Szymanski L, Adrian V, Egan AM. Diabetic Ketoacidosis in Pregnancy: Clinical Risk Factors, Presentation, and Outcomes. J Clin Endocrinol Metab 2022; 107:3137-3143. [PMID: 35917830 PMCID: PMC9681617 DOI: 10.1210/clinem/dgac464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Diabetic ketoacidosis (DKA) in pregnancy is an obstetric emergency with risk of maternofetal death. OBJECTIVE This work aimed to evaluate DKA events in pregnant women admitted to our inpatient obstetric service, and to examine associated clinical risk factors, presentation, and pregnancy outcomes. METHODS A retrospective cohort study was conducted at the Mayo Clinic, Rochester, Minnesota, USA, and included women aged 17 to 45 years who were treated for DKA during pregnancy between January 1, 2004 and December 31, 2021. Main outcome measures included maternal and fetal death along with a broad spectrum of maternal and fetal pregnancy outcomes. RESULTS A total of 71 DKA events were identified in 58 pregnancies among 51 women, 48 (82.8%) of whom had type 1 diabetes. There were no maternal deaths, but fetal demise occurred in 10 (17.2%) pregnancies (6 miscarriages and 4 stillbirths). Maternal social stressors were frequently present (n = 30, 51.0%), and glycemic control was suboptimal (median first trimester glycated hemoglobin A1c = 9.0%). Preeclampsia was diagnosed in 17 (29.3%) pregnancies. Infants born to women with DKA were large for gestational age (n = 16, 33.3%), suffered from neonatal hypoglycemia (n = 29, 60.4%) and required intensive care unit admission (n = 25, 52.1%). CONCLUSION DKA is associated with a high rate of maternofetal morbidity and fetal loss. Prenatal education strategies for women with diabetes mellitus should include a strong focus on DKA prevention, and clinicians and patients should have a high index of suspicion for DKA in all pregnant women who present with symptoms that could be attributed to this condition.
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Affiliation(s)
- Maheswaran Dhanasekaran
- Correspondence: Maheswaran Dhanasekaran, MBBS, Department of Endocrinology, Diabetes, Metabolism and Nutrition, 200 1st St SW, Rochester, MN 55905, USA.
| | - Sneha Mohan
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Dana Erickson
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Pankaj Shah
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Linda Szymanski
- Division of Maternal and Fetal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Vella Adrian
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Aoife M Egan
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA
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7
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Newman C, Egan AM, Ahern T, Al-Kiyumi M, Bacon S, Bahaeldein E, Balan G, Brassill MJ, Breslin E, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Elhilo K, Cullen E, Fenlon M, Ferry P, Gabir A, Guinan L, Hanlon G, Heffernan M, Higgins T, Hoashi S, Kgosidialwa O, Khamis A, Kinsley B, Kirwan B, James A, Kyithar P, Liew A, Malik I, Matthews L, McGurk C, McHugh C, Moloney Y, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor A, O'Connor E, O'Halloran D, O'Mahoney L, O'Shea T, O'Sullivan EP, Peters M, Roberts G, Rooney H, Sharma J, Smyth A, Synnott M, Tarachand B, Tighe M, Todd M, Towers M, Tuthill A, Mahmood W, Yousif O, Dunne FP. Retrospective national cohort study of pregnancy outcomes for women with type 1 and type 2 diabetes mellitus in Republic of Ireland. Diabetes Res Clin Pract 2022; 189:109947. [PMID: 35709911 DOI: 10.1016/j.diabres.2022.109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/14/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
AIM Report the outcomes of pregnant women with type 1 and type 2 diabetes and to identify modifiable and non-modifiable factors associated with poor outcomes. METHODS Retrospective analysis of pregnancy preparedness, pregnancy care and outcomes in the Republic of Ireland from 2015 to 2020 and subsequent multivariate analysis. RESULTS In total 1104 pregnancies were included. Less than one third attended pre-pregnancy care (PPC), mean first trimester haemoglobin A1c was 7.2 ± 3.6% (55.5 ± 15.7 mmol/mol) and 52% received pre-conceptual folic acid. Poor preparation translated into poorer pregnancy outcomes. Livebirth rates (80%) were comparable to the background population however stillbirth rates were 8.7/1000 (four times the national rate). Congenital anomalies occurred in 42.5/1000 births (1.5 times the background rate). More than half of infants were large for gestational age and 47% were admitted to critical care. Multivariate analyses showed strong associations between non-attendance at PPC, poor glycaemic control and critical care admission (adjusted odds ratio of 1.68 (1.48-1.96) and 1.61 (1.43-1.86), p < 0.05 respectively) for women with type 1 diabetes. Smoking and teratogenic medications were also associated with critical care admission and hypertensive disorders of pregnancy. CONCLUSION Pregnancy outcomes in women with diabetes are suboptimal. Significant effort is needed to optimize the modifiable factors identified in this study.
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Affiliation(s)
| | - Aoife M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States of America
| | - Tomas Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Republic of Ireland
| | - Maisa Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Siobhan Bacon
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | | | - Gabriela Balan
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Mary-Jane Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Republic of Ireland
| | - Emily Breslin
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | | | | | - Hilda Clarke
- Portiuncula University Hospital, Co Galway, Republic of Ireland
| | | | - Linda Culliney
- Cork University Hospital, Cork, Co Cork, Republic of Ireland
| | - Recie Davern
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Maeve Durkan
- Bon Secours Hospital, Cork, Co Cork, Republic of Ireland
| | - Kalthoom Elhilo
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Elizabeth Cullen
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Mairead Fenlon
- Wexford General Hospital, Co Wexford, Republic of Ireland
| | - Pauline Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland
| | - Ahmed Gabir
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | - Linda Guinan
- South Tipperary General Hospital, Clonmel, Co Tipperary, Republic of Ireland
| | - Geraldine Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Republic of Ireland
| | - Marie Heffernan
- South Infirmary Victoria University Hospital, Cork, Co Cork, Republic of Ireland
| | - Tom Higgins
- University Hospital Kerry, Tralee, Co Kerry, Republic of Ireland
| | - Shu Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Republic of Ireland
| | | | - Amjed Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland
| | - Brendan Kinsley
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Breda Kirwan
- Galway University Hospital, Galway, Republic of Ireland
| | - Anne James
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Republic of Ireland
| | - Pyeh Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Aaron Liew
- Portiuncula University Hospital, Co Galway, Republic of Ireland
| | | | - Linda Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Republic of Ireland
| | - Colm McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Republic of Ireland
| | - Cathy McHugh
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | - Yvonne Moloney
- University of Limerick UL Hospitals Group, Co Limerick, Republic of Ireland
| | - Matt S Murphy
- South Infirmary Victoria University Hospital, Cork, Co Cork, Republic of Ireland
| | - Paula Murphy
- Cork University Hospital, Cork, Co Cork, Republic of Ireland
| | - Dina Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Eoin Noctor
- University of Limerick UL Hospitals Group, Co Limerick, Republic of Ireland
| | - Marie Nolan
- University Hospital Kerry, Tralee, Co Kerry, Republic of Ireland
| | - Aislong O'Connor
- Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland
| | - Emily O'Connor
- Portiuncula University Hospital, Co Galway, Republic of Ireland
| | | | - Linda O'Mahoney
- Cork University Hospital, Cork, Co Cork, Republic of Ireland
| | - Triona O'Shea
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | | | - Moby Peters
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | - Graham Roberts
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | - Hannorah Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Republic of Ireland
| | - Jayant Sharma
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Aoife Smyth
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Maria Synnott
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | | | - Marie Tighe
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | - Marie Todd
- Mayo University Hospital, Co Mayo, Republic of Ireland
| | - Michael Towers
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | | | - Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Obada Yousif
- Wexford General Hospital, Co Wexford, Republic of Ireland
| | | |
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