T1D and pregnancy: preterm birth risk is strongly linked to periconception HbA1c

  • Ludvigsson JF & al.
  • Ann Intern Med
  • 23 abr. 2019

  • de Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Preterm birth risk was strongly linked to periconceptional HbA1c levels among women with type 1 diabetes (T1D), and excess risk was seen even within the recommended range.

Why this matters

  • The relationship between maternal glycemic control and preterm birth has been unclear.

Study design

  • Swedish population-based cohort study of 2474 singleton infants born to women with T1D and 1,165,216 infants born to 746,916 women without T1D.
  • Funding: Swedish Diabetes Foundation.

Key results

  • Preterm birth (
  • Preterm birth incidence:
    • HbA1c
    • HbA1c 6.5%-7.7%: 20.6%. 
    • HbA1c 7.8%-9.1%: 28.3%.
    • HbA1c >9.1%: 37.5%.  
  • Adjusted risk ratios (aRRs; 95% CIs) for preterm birth in T1D vs non-T1D, by HbA1c:
    • 6.5%-7.7%: 4.22 (3.74-4.75); 
    • 7.8%-9.1%: 5.56 (4.84-6.38); and
    • >9.1%: 6.91 (5.85-8.17).
  • With HbA1c cutoff lowered to
  • Higher HbA1c levels were associated with secondary outcomes of large for gestational age, hypoglycemia, respiratory distress, Apgar score

Limitations

  • Possible residual confounding.
  • HbA1c values not available for all patients with T1D.
  • No data on physical activity, drinking habits, or race/ethnicity.
  • BMI based on self-reported height.  
  • All-Swedish population.