Correlations between parameters of glycaemic variability and foetal growth, neonatal hypoglycaemia and hyperbilirubinemia in women with gestational diabetes

Exploring glycemic variability and time in range: Emerging indicators of at-risk pregnancy in type 2 diabetes mellitus

OBJECTIVE

This study compares ambulatory glycemic profile and glycemic variability between pregnant women diagnosed with type 2 diabetes mellitus (T2DM) receiving pharmacotherapy and healthy pregnant women without diabetes and assesses their correlation with fetal outcome.

METHOD

This was a case-control study involving 60 pregnant women (40 with T2DM and 20 healthy controls) in the third trimester of pregnancy. A flash glucose monitor device was applied over the upper arm to obtain the ambulatory glucose profile. Various glycemic parameters were analyzed and correlated with fetal outcomes among the two groups.

RESULTS

A total of 720 days of glucose data, comprising 69 120 data points, were analyzed. This included 46 080 glucose values from the T2DM group and 23 040 from the healthy control group. Mean glucose levels in the T2DM group were 23.75% higher compared to the controls. All measures of glycemic variability were significantly elevated in the T2DM group, including mean amplitude of glycemic excursions (MAGE) (52.85 mg/dL vs. 35.72 mg/dL, P = 0.036) and standard deviation (22.84 mg/dL vs. 14.00 mg/dL, P = 0.029). A MAGE >55 mg/dL was associated with adverse fetal outcomes, such as large-for-gestational-age (LGA) infants, neonatal hypoglycemia, and stillbirth. In the T2DM group, poor outcomes were also linked to a higher time above range (TAR) (13.39% vs. 2.5%, P = 0.0001). The LGA subgroup exhibited an elevated TAR (15.2%) compared to those with normal outcomes.

CONCLUSION

Pregnant women with T2DM exhibit higher glycemic variability compared to healthy pregnant women. A MAGE >55 mg/dL was associated with adverse fetal outcomes, and elevated TAR significantly influenced these outcomes.

Developing and evaluating a predictive model for neonatal hyperbilirubinemia based on UGT1A1 gene polymorphism and clinical risk factors

Background

Neonatal hyperbilirubinemia (NHB) is one of the most common diseases in the neonatal period. Without timely diagnosis and treatment, it can lead to long-term complications. In severe cases, it may even result in fatality. The UGT1A1 gene and clinical risk factors play important roles in the development and progression of NHB.

Methods

In this study, we conducted a cohort study and analyzed 3258 newborns from the Jilin Women And Children Health Hospital in northern China, including 372 children with hyperbilirubinemia. We established a predictive model using a logistic regression model based on clinical risk factors and the polymorphism of the G211A locus in the UGT1A1 gene of newborns. Furthermore, the performance of the prediction model was evaluated using the ROC curve.

Results

The logistic regression model indicates that the following factors are associated with an increased risk of NHB: the time when stool turns yellow [P ≤ 0.001, OR 1.266 (95% CI: 1.125-1.425)]; neonatal cephalohematoma [P ≤ 0.001, OR 33.642 (95% CI: 21.823-51.861)]; hemolytic disease of newborn [P ≤ 0.001, OR 33.849 (95% CI: 18.589-61.636)]; neonatal weight loss [P ≤ 0.001, OR 11.275 (95% CI: 7.842-16.209)]; neonatal premature rupture of membranes (PROM) history [P = 0.021, OR 1.422 (95% CI: 1.056-1.917)]; genetic polymorphism at the UGT1A1 gene G211A locus. Gestational age is a protective factor [P ≤ 0.001, OR 0.766 (95% CI: 0.686-0.855)]. Compared to natural labor, cesarean section is a protective factor [P = 0.011, OR 0.711 (95% CI: 0.546-0.926)], while assisted delivery is a risk factor [P = 0.022, OR 2.207 (95% CI: 1.121-4.346)]. The area under the curve (AUC) of this prediction model is 0.804 (95% CI: 0.777-0.831), indicating good discrimination ability and value for predicting the risk of NHB after birth.

Conclusion

We have developed and evaluated a predictive model that combines UGT1A1 gene polymorphism and clinical risk factors for the first time. By using this nomogram and taking into account the results of serum total bilirubin measurement or transcutaneous bilirubin measurement, early prediction of the risk of neonatal hyperbilirubinemia can be achieved.