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and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study
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Dr Svetlana Glinyanaya
Professor Rudy Bilous
Professor Judith Rankin
Dr Ruth Bell
Glinianaia SV, Tennant PWG, Bilous RW, Rankin J, Bell R
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To investigate clinical and socio-demographic predictors of birth weight in singletons born to women with type 1 or type 2 diabetes.
Normally formed singleton live births and intrapartum stillbirths, born to women with pre-conception diabetes during 1996-2008, were identified from the population-based Northern Diabetes in Pregnancy Survey (n=1505). Associations between potential predictors and birth weight were analysed by multiple regression.
Potentially modifiable independent predictors of increase in birth weight were pre-pregnancy care (adjusted regression coefficient, b=87.1g, 95% CI:12.9, 161.3), increasing third trimester HbA1c up to 7% (53mmol/mol) (b=310.5g per 1% [11mmol/mol], 95% CI:246.3, 374.7) and increasing maternal BMI (b=9.5g per 1kg/m2, 95% CI:3.5, 15.5). Smoking during pregnancy (b=-145.1g, 95% CI:-231.4, -58.8), later gestation at booking (b=-15.0g, 95% CI:-26.9, -3.0) and higher peri-conception HbA1c (b=-48.2g, 95% CI:-68.8, -27.6) were independently associated with birth weight reduction. Pre-pregnancy nephropathy (b=-282.7g, 95% CI:-461.8, -103.6) and retinopathy (b=-175.5g, 95% CI:-269.9, -81.0) were independent non-modifiable predictors of reduced birth weight, while higher maternal height was a non-modifiable predictor of increasing birth weight (b=17.8g, 95% CI:12.3, 23.2). Other predictors of birth weight increase were male sex, multiparity and increasing gestational age at delivery. Type or duration of diabetes, socioeconomic status and ethnicity were not associated with continuous birth weight.
Poor glycaemic control before and throughout pregnancy is associated with abnormal fetal growth, with increasing peri-conception HbA1c predicting weight reduction and increasing third trimester HbA1c predicting increased birth weight. Women with microvascular complications of diabetes may require increased surveillance to detect fetal growth restriction.
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