1. Introduction Materials and Methods Results Conclusions
Maternal lipids are associated with large for gestational birth weight
in women with type 1 diabetes:
results from a prospective single-center study
Pawel Gutaj, Ewa Wender- Ozegowska, Jacek Brazert
Department of Obstetrics and Women’s Diseases
Poznan University of Medical Sciences, Poland
Introduction
Table 1. Comparison of laboratory characteristics between study groups
Despite improvement in diabetes care over the years, incidence of large for gestational age (LGA) is still very high even in a well controlled type 1 diabetic mothers.
Maternal lipids have been suggested to play significant role in fetal growth. However, data on the association of lipids and LGA in women with T1DM is scarce.
Therefore, the aim of our study was to determine whether changes in maternal lipids might contribute to high rates of LGA in this population.
AGA
N=85
LGA
N=30 P
HbA1c I , %; mmol/mol [Median (IQR)]
6.2 ( ); 44 (40-552)
6.9 ( ); 52 (43-60)
0.1
HbA1c II, %; mmol/mol [Median (IQR)]
5.4 ( );
36 (32-39)
5.8 ( )
40 (38-43)
0.0002
HbA1c III, %; mmol/mol [Median (IQR)]
5.7 ( );
39 (37-44)
6.2 ( );
44 (41-49)
0.0015
HDL I,mmol/L [Median (IQR)]
1.99 ( )
1.64 ( )
0.0012
HDL II,mmol/L [Median (IQR)]
2.32 ( )
2.17 ( )
0.05
HDL III,mmol/L [Median (IQR)]
2.08 ( )
1.85 ( )
0.03
TG I, mmol/L [Median (IQR)]
0.62 ( )
0.75 ( )
0.04
TG II, mmol/L [Median (IQR)]
1.40 ( )
1.58 ( )
0.27
TG III, mmol/L [Median (IQR)]
2.32 ( )
2.61 ( )
Materials and Methods
Study design: Prospective single-center study on a population of 171 women with T1DM admitted to the perinatal center for women with diabetes between June 2012 and December 2014.
Anthropometric, clinical and laboratory data (HbA1c, total cholesterol, HDL, LDL, triglycerides were collected during 3 planned hospitalizations: in the first trimester (<12th week), in mid-pregnancy (20th- 24th weeks) and before delivery (34th-39th weeks). All multivariate models were adjusted for maternal age, duration of diabetes, BMI, gestational weight gain, parity (mulitpara vs. primipara), mode of insulin therapy (CSII vs. MDI) and HbA1c
Results
Table 2. Prediction of LGA with maternal lipids (mmol/L) and HbA1c (%) using multivariate logistic regression models. Data shown as adjusted odds ratios (OR) and associated 95% confidence intervals (95%CI).
Fifty- seven women were excluded from the study group due the following: multiple pregnancy, spontaneous abortions, preeclampsia, and delivery in a different hospital/loss of follow-up, giving a group of 114 women included in the final analysis (LGA=30; AGA=84). Laboratory characteristics of the AGA and LGA groups are compared in Table 1.
In the multivariate logistic regression analysis lower HDL concentration in the first trimester was significantly associated with LGA (p=0.01). Similar association was observed for the HDL concentrations in mid-pregnancy (p=0.04) and before delivery (p=0.03). Higher triglycerides concentrations in the first trimester (p=0.02) and before delivery (p=0.008) were associated with increased risk of LGA. There was no association between second trimester TG and LGA. Both total cholesterol and LDL were not associated with LGA. Higher HbA1c was associated with LGA in the second trimester (p=0.01) and before delivery (p=0.02). There was no association between first trimester HbA1c and LGA.
Odds ratio (95% CI)
Coefficient P
HDL I
0.225 ( )
-1.49
0.01
HDL II
0.329 ( )
-1.11
0.04
HDL III
0.304 ( )
-0.19
0.03
TG I
5.522 ( )
1.71
0.02
TG III
2.14 ( )
0.76
0.008
HbA1c II
2.279 ( )
0.824
HbA1c III
1.962 ( )
0.674
Models adjusted for maternal age, duration of diabetes, BMI at onset of the study, gestational weight gain, parity (multipara=1 vs. primipara=0), mode of insulin therapy (CSII=1 vs. MDI=0).
Models assessing lipids were additionally adjusted for HbA1c from the same follow-up hospitalization.
Conclusions
Our study confirms the important role of maternal HDL and TG in promoting excessive fetal growth in women with T1DM. However, large epidemiological studies are needed to establish outcome-based reference thresholds for lipids in pregnancy. Data derived from such studies would provide the basis for interventional trials aimed at modification of lipids during pregnancy, especially in high-risk patients.