Natalia Hillman

Is Pregnancy Outcome Worse in Type 2 Than in Type 1 Diabetic Women

Most research on pregestational diabetes has focused on type 1 diabetes, and surprisingly little knowledge exists concerning outcomes of pregnancies of women with type 2 diabetes. A dearth of published data suggest outcomes similar to those of type 1 diabetic women (1,2), although recent studies report poorer outcomes in women with type 2 diabetes (3–7). We retrospectively compared maternal and perinatal outcomes of 93 consecutive singleton pregnancies in women with type 2 diabetes and 532 consecutive singleton pregnancies in women with type 1 diabetes referred to the Diabetes and Pregnancy Unit at University Hospital La Paz from 1984 to 2004. Women with type 2 diabetes were significantly older ([means ± SD] 31.8 ± 5.5 …

Use of insulin lispro during pregnancy in women with pregestational diabetes mellitus.

BACKGROUND AND OBJECTIVE To assess the safety and efficacy of insulin analogues versus human insulin in pregnant women with pregestational diabetes. PATIENTS AND METHODS We collected data on pregnant women with type 1 or type 2 diabetes who were attended at the Diabetes and Pregnancy Unit between January 1998 and April 2008 (N=351). Two hundred and forty one patients were treated with regular insulin and NPH and 110 were treated with different combinations of insulins including an insulin analogue (most of them with NPH and lispro). RESULTS There was no significant difference in terms of congenital malformation rate between groups (3.3% and 3.6%). The group on insulin analogue had slightly higher mean HbA1c during the first trimester than the group on human insulin (6.6 [1.0]% vs 6.9 [1.1]%; P=0,022) and needed smaller insulin doses during whole pregnancy. Severe hypoglycaemia was significantly less frequent among women treated with a rapid insulin analogue (2.3 vs 10.0%; P=0,025). Neonatal hypoglycaemia was significantly more frequent in the group treated with a rapid insulin analogue (34.9 vs 23.6%; P=0.043) due to the concomitant use of an insulin pump. Other obstetric and neonatal variables were not different between the two groups. CONCLUSION Our study shows that insulin analogues are safe during pregnancy in women with pregestational diabetes mellitus. Overall, glycaemic control, maternal and foetal outcome were similar to those with human insulin. The main advantage with respect to human insulin was to importantly reduce maternal severe hypoglycaemia.

The Relative Contribution of Ethnicity, Overweight and Gestational Diabetes Severity to Postpartum Abnormal Glucose Tolerance

Aim: To analyze the influence of ethnicity, body mass index (BMI) and gestational diabetes (GDM) severity on abnormal glucose metabolism at the early postpartum. Methods: Glucose tolerance (WHO criteria) was evaluated at 3-9 months after delivery in a group of 71 GDM women (NDDG criteria) coming from Latin America, 43 from Africa and 14 from Asia or Pacific Islands. Their glucose tolerance was compared to 1,948 European control women by prepregnancy and postpartum BMI and by GDM severity. The effect of these parameters was adjusted for age, family history of diabetes, previous gestational diabetes, gestational age at GDM diagnosis and excess gestational weight gain. Results: Postpartum glucose tolerance was abnormal in 37.3% of women. Asian-Pacific Islanders (64.3%), Latinas (62.8%) and African (50.4%) had glucose metabolism abnormalities more frequently than European (35.5%) mothers (P<0.001). There was an effect of being overweight (AOR 1.38, 95% CI 1.121.71, P<0.001), obese (2.10, 1.56-2.83, P<0.001) prepregnancy and of non-European geographic origin (1.80, 1.2-2.7, P=0.004) on postpartum impaired glucose metabolism in the adjusted analysis. The main predictors of postpartum dysglycemia were prepregnancy obesity and GDM fasting glycemia in both non-European and European groups. The effect of ethnicity disappeared when the effect of postpartum BMI (2.14, 1.61-2.84, P<0.001 of overweight; 2.31, 1.60-3.32, P<0.001 of obesity) was considered. Conclusion: The effect of body weight is stronger than that of ethnicity on postpartum dysglycemia in women with recent gestational diabetes.

Metabolic syndrome and impaired glucose metabolism during early postpartum after twin pregnancies complicated by gestational diabetes mellitus: Is the risk comparable to singleton pregnancies?

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since mercredi 22 novembre 2017

Diabetes mellitus gestacional: control glucémico durante el embarazo y su relación con los resultados neonatales en embarazos gemelares y de feto único

OBJECTIVE To assess the impact of glycemic control in gestational on neonatal weight and metabolic complications of twin and singleton pregnancies. METHODS An observational, retrospective study to monitor 120 twin and 240 singleton pregnancies in women with GDM. Maternal glycemic parameters during pregnancy (oral glucose tolerance test results, treatment, insulinization rate, mean HbA1c in the third trimester), and neonatal complications and weight were recorded. RESULTS A higher infant birth weight ratio (IBWR 1.02±0.12 vs. 0.88±0.12, P<.001) and a lower rate of newborns small for gestational age (severe SGA 2.5% vs. 8.3%, P=.012) were seen after singleton pregnancies as compared to twin pregnancies. The rates of newborns large for gestational age (LGA 12.6% vs. 12.5%, P=.989); macrosomic (6.7% vs. 7.5%, P=.777); or small for gestational age (SGA 6.7% vs. 10.8%, P=.175) were similar in both groups. Neonates from twin pregnancies had a higher risk of hypoglycemia (adjusted OR 4.71; 1.38-16.07, P=.013) and polycythemia (adjusted OR 10.05; 1.82-55.42, P=0.008). A linear relationship was seen between third trimester HbA1c levels and IBWR in singleton (r=.199, P=.003), but not in twin pregnancies (r=0.049, P=0.610). CONCLUSIONS Risk of severe SGA, hypoglycemia, and polycythemia was significantly higher in twin pregnancies of women with GDM. Neonatal weight outcomes and metabolic complications in twin pregnancies of women with GDM were not related to glycemic control. Moreover, in our study population, fasting glucose at diagnosis and mean HbA1c in the third trimester showed a linear relationship with higher birth weights in singleton, but not in twin pregnancies.