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Maternal Glycemic Control in Type 1 Diabetes and the Risk for Preterm Birth: A Population-Based Cohort Study
Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden: University of Nottingham, Nottingham, United Kingdom; Columbia University College of Physicians and Surgeons NY, New York, USA.ORCID iD: 0000-0003-1024-5602
Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-2300-3055
Karolinska Institutet, Stockholm, Sweden.
Karolinska Institutet, Stockholm, Sweden; Centre of Registers Västra Götaland and University of Gothenburg, Gothenburg, Sweden.
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2019 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 170, no 10, p. 691-701Article in journal (Refereed) Published
Abstract [en]

Background: Maternal type 1 diabetes (T1D) has been linked to preterm birth and other adverse pregnancy outcomes. How these risks vary with glycated hemoglobin (or hemoglobin A(1c) [HbA(1c)]) levels is unclear.

Objective: To examine preterm birth risk according to periconceptional HbA(1c) levels in women with T1D.

Design: Population-based cohort study.

Setting: Sweden, 2003 to 2014.

Patients: 2474 singletons born to women with T1D and 1 165 216 reference infants born to women without diabetes.

Measurements: Risk for preterm birth (< 37 gestational weeks). Secondary outcomes were neonatal death, large for gestational age, macrosomia, infant birth injury, hypoglycemia, respiratory distress, 5-minute Apgar score less than 7, and stillbirth. Results: Preterm birth occurred in 552 (22.3%) of 2474 infants born to mothers with T1D versus 54 287 (4.7%) in 1 165 216 infants born to mothers without diabetes. The incidence of preterm birth was 13.2% in women with a periconceptional HbA(1c) level below 6.5% (adjusted risk ratio [aRR] vs. women without T1D, 2.83 [95% CI, 2.28 to 3.52]), 20.6% in those with a level from 6.5% to less than 7.8% (aRR, 4.22 [CI, 3.74 to 4.75]), 28.3% in those with a level from 7.8% to less than 9.1% (aRR, 5.56 [CI, 4.84 to 6.38]), and 37.5% in those with a level of 9.1% or higher (aRR, 6.91 [CI, 5.85 to 8.17]). The corresponding aRRs for medically indicated preterm birth (n = 320) were 5.26 (CI, 3.83 to 7.22), 7.42 (CI, 6.21 to 8.86), 11.75 (CI, 9.72 to 14.20), and 17.51 (CI, 14.14 to 21.69), respectively. The corresponding aRRs for spontaneous preterm birth (n = 223) were 1.81 (CI, 1.31 to 2.52), 2.86 (CI, 2.38 to 3.44), 2.88 (CI, 2.23 to 3.71), and 2.80 (CI, 1.94 to 4.03), respectively. Increasing HbA(1c) levels were associated with the study's secondary outcomes: large for gestational age, hypoglycemia, respiratory distress, low Apgar score, neonatal death, and stillbirth.

Limitation: Because HbA(1c) levels were registered annually at routine visits, they were not available for all pregnant women with T1D.

Conclusion: The risk for preterm birth was strongly linked to periconceptional HbA(1c) levels. Women with HbA(1c) levels consistent with recommended target levels also were at increased risk. Primary Funding Source: Swedish Diabetes Foundation.

Place, publisher, year, edition, pages
American College of Physicians , 2019. Vol. 170, no 10, p. 691-701
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-74540DOI: 10.7326/M18-1974ISI: 000468333600017PubMedID: 31009941OAI: oai:DiVA.org:oru-74540DiVA, id: diva2:1319852
Funder
Swedish Research Council, 2016-01974 2013-2429
Note

Funding Agencies:

Swedish Diabetes Foundation  

Strategic Research Area Epidemiology Program at Karolinska Institutet 

Stockholm County Council (ALF project)  20130156 

Strategic Research Program in Epidemiology at Karolinska Institutet 

Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-06-03Bibliographically approved

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Ludvigsson, Jonas F.

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