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Precision Prediction & Precision Medicine

GLYCEMIC VARIABILITY AND PREGNANCY

Riëlle Hoek-Hogchem, Sarah Bovenberg, Pim Dekker, Erwin Birnie, Henk Veeze, Hans J. Duvekot, Sander Galjaard, Henk-Jan Aanstoot

Effects of peri-conception and pregnancy glycemic variability on pregnancy and perinatal complications in type 1 diabetes: a pilot study. Exp Clin Endocrinol Diabetes. 2022 Nov;130(11):740-750.

In November 2019-2020 Riëlle Hoek-Hogchem did her 24-week internship at Diabeter. At the time she was a medical student from the Vrije Universiteit Amsterdam interested in Obstetrics, specifically in high-risk pregnancies. At Diabeter she worked on the GLYcaemic Variability in the Preconception Period in women with type 1 Diabetes on the occurrence of Pregnancy- and Perinatal complications (GLYVAP4) study as part of her graduation project. The results have now been published.

 

Pregnancy in women with type 1 diabetes is associated with higher complication risks, which can be reduced by optimal glycaemic control before and during pregnancy. It has been shown that perinatal and neonatal complications remain high despite adequate glycaemic control in women with type 1 diabetes. It is not yet known if and to what extent pre-conceptional glycaemic variability (GV) is associated with pregnancy- and perinatal complications.

The GLYVAP4 study assessesd if there is an association between pre-conception GV and pregnancy/perinatal maternal and neonatal complications. If so, GV could facilitate identification of high-risk pregnancies in women with type 1 Diabetes. Of 63 eligible women, 29 women (38 pregnancies) were included. Maternal and neonatal complications were summarized using a composite total complication score. Pre-/periconceptional GV and GV during all three trimesters was expressed as mean glucose, standard deviation (SD), Coefficient of Variation (CV), High Blood Glucose Index (HBGI), Low Blood Glucose Index (LBGI) and Average Daily Risk Range (ADRR).

 

Key findings:

  • Periconceptional GV and GV during the 1st and 2nd trimester, expressed as ADRR, was positively associated with pregnancy and perinatal complications to both mother and child
  • During pregnancy, ADRR decreased from high-risk values to moderate-risk values
  • The associations for the other GV metrics were less clear, but the magnitude of the odds ratios indicate that GV during the 1st and 2nd trimester may be associated with pregnancy and perinatal complications

 

Concluding, the authors state that

"….our data suggest that careful monitoring of GV during (pre)conception is important. However, despite the positive association between periconceptional GV as measured by ADRR and pregnancy and perinatal complications, more evidence is needed to substantiate the relation between pre- and periconceptional GV and pregnancy and perinatal complications, and to determine the optimal (combination of) GV metric(s) and cut-offs to identify women with type 1 diabetes with an increased risk for adverse pregnancy outcomes " -

Please click here for the pdf file.

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