母体血糖控制与 1 型糖尿病妊娠新生儿低血糖风险：CONCEPTT 试验的二次分析。

Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial.

机构信息

Departments of Medicine and Obstetrics and Gynaecology, University of Calgary, Calgary, Canada.

Alberta Children's Hospital Research Institute, Calgary, Canada.

出版信息

Diabet Med. 2019 Aug;36(8):1046-1053. doi: 10.1111/dme.13988. Epub 2019 Jun 17.

DOI:10.1111/dme.13988

PMID:31107983

Abstract

AIMS

To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants.

METHODS

A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose.

RESULTS

Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA [48 ± 7 (6.6 ± 0.6) vs. 45 ± 7 (6.2 ± 0.6); P = 0.0009 and 50 ± 7 (6.7 ± 0.6) vs. 46 ± 7 (6.3 ± 0.6); P = 0.0001] and lower continuous glucose monitoring time-in-range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C-peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P ≤ 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia.

CONCLUSIONS

Modest increments in continuous glucose monitoring time-in-target (5-7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period.

摘要

目的

使用传统和连续血糖监测指标，在 1 型糖尿病妊娠试验中的连续血糖监测（CONCEPTT）参与者中，检查产妇血糖控制与新生儿低血糖风险之间的关系。

方法

CONCEPTT 的二次分析涉及 225 名孕妇及其活产婴儿。在妊娠 12、24 和 34 周时评估产前血糖。产时血糖通过分娩前 24 小时的连续血糖监测措施进行评估。主要结局是新生儿低血糖定义为血糖浓度<2.6mmol/l并需要静脉注射葡萄糖。

结果

225 名婴儿中有 57 名（25.3%）发生新生儿低血糖，21 名（15%）为足月和 36 名（40%）早产儿。在第二和第三个三个月，新生儿低血糖的母亲有更高的 HbA[48±7（6.6±0.6）比 45±7（6.2±0.6）；P=0.0009 和 50±7（6.7±0.6）比 46±7（6.3±0.6）；P=0.0001]和更低的连续血糖监测时间范围（46%比 53%；P=0.004 和 60%比 66%；P=0.03）。低血糖新生儿的脐带血 C 肽浓度更高[1416（834，2757）比 662（417，1086）pmol/l；P<0.00001]、出生体重超过第 97.7 百分位数（63%比 34%；P<0.0001）和皮褶厚度（P≤0.02）。有 33 名参与者进行了产时连续血糖监测，低血糖新生儿的母亲与无低血糖新生儿的母亲之间没有差异。