Pregnancy in Type 1 Diabetes: Glucose Control Can Reduce Fetal Overgrowth Interview with:

Rachel McGrath BSc (Hons), PhD Senior Research Fellow - Department of Endocrinology, RNSH Clinical Senior Lecturer - Northern Clinical School University of Sydney

Dr. Rachel McGrath

Rachel McGrath BSc (Hons), PhD
Senior Research Fellow – Department of Endocrinology, RNSH
Clinical Senior Lecturer – Northern Clinical School
University of Sydney What is the background for this study? What are the main findings?

Response: Women with type 1 diabetes are significantly more likely to experience complications during pregnancy and to have infants with high birth weights. This can result in adverse outcomes at the time of delivery for both mother and baby, and can also predispose infants to obesity and chronic disease in later life.

The relationship between maternal blood glucose levels and foetal growth in type 1 diabetes in pregnancy has not been completely elucidated. Thus, we examined the association between maternal glycaemic control and foetal growth by examining serial ultrasound measurements and also by determining the relationship between HbA1c (a measure of circulating glucose exposure over a three month time period) and infant birth weight.

We found that maternal glucose levels were directly related to foetal abdominal circumference in the late second and third trimesters and also to birth weight. We also confirmed the results of previous studies to show that the optimal HbA1c during pregnancy to reduce the likelihood of large-for-gestational-age neonates is < 6%. What should readers take away from your report?

Response: The findings of this study reinforce the recent recommendations from the American Diabetes Association that women with type 1 diabetes in pregnancy maintain an HbA1c level below 6% where possible without increasing the risk of hypoglycaemia or low blood glucose levels. This can reduce the risk of foetal overgrowth and lead to better perinatal outcomes. What recommendations do you have for future research as a result of this work?

Response: Several studies have examined the relationship between maternal glucose control and neonatal size in type 1 diabetes and pregnancy, with conflicting results. Further research is required to determine other drives of excess foetal growth in type 1 diabetes, including glycaemic variability, maternal BMI, gestational weight gain and lipid levels. Is there anything else you would like to add? 

Response: We also recently published a prospective study in type 1 diabetes in pregnancy and found that higher glycaemic variability between 24-28 weeks’ gestation was significantly associated with large-for-gestational-age neonates (McGrath et al, Diabetes Care, 2017), further underlining the importance of determining the mechanisms underpinning excess foetal growth in this population of women.

There are no relevant disclosures to report. 


Excess foetal growth and glycaemic control in type 1 diabetes and pregnancy
S.Ring,S.J.Glastras,S.L.HockingS.K.Seeho,E.S.Scott, G.R.FulcherR.T.McGrath
Diabetes & Metabolism
Available online 11 January 2018!

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