Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia.
Gregory R FulcherSarah J GlastrasSamantha L HockingGregory R FulcherPublished in: Diabetes care (2018)
Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia. We review potential contributors to excess fetal growth in pregnancies complicated by type 1 diabetes. In addition to hyperglycemia, we explore the role of glycemic variability, prepregnancy overweight and obesity, gestational weight gain, and maternal lipid levels. Greater understanding of the stimuli that drive excess fetal growth could lead to targeted management strategies in pregnant women with type 1 diabetes, potentially reducing the incidence of LGA neonates and the inherent risk of acute and long-term complications.
Keyphrases
- birth weight
- gestational age
- glycemic control
- type diabetes
- preterm birth
- weight gain
- pregnancy outcomes
- low birth weight
- pregnant women
- weight loss
- blood glucose
- body mass index
- insulin resistance
- polycystic ovary syndrome
- risk factors
- liver failure
- cardiovascular disease
- metabolic syndrome
- intensive care unit
- emergency department
- risk assessment
- diabetic rats
- high fat diet induced
- cancer therapy
- oxidative stress
- aortic dissection
- extracorporeal membrane oxygenation