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Acta Diabetologica

Erschienen in:

01.09.2010 | Review Article

Pregnancy complicated by diabetes: what is the best level of HbA1c for conception?

verfasst von: Annunziata Lapolla, Maria Grazia Dalfrà, Domenico Fedele

Erschienen in: Acta Diabetologica | Ausgabe 3/2010

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Abstract

To reduce the congenital malformations that occur in pregnancies complicated by diabetes, it is essential to achieve and maintain a good metabolic control before conception. In this context, measuring HbA1c is considered as the gold standard for monitoring metabolic control in diabetes and various different HbA1c levels have been recommended as optimal in the preconception period for diabetic women planning a pregnancy. An analysis of key studies published on this issue until now clearly shows that HbA1c levels correlate closely with the occurrence of congenital malformations and other neonatal complications characteristic of pregnant diabetic women. HbA1c is therefore one of the key markers to use in monitoring metabolic control, and the most reasonable approach would seem to be to use a standardized measurement method and aim for HbA1c levels resembling normal values as closely as possible, with a view to preventing episodes of hypoglycemia.

Diabetes care and research in Europe: the Saint Vincent Declaration (1990) Diabet Med 7:360

Reece EA, Homko CJ (2000) Why do diabetic women deliver malformed infants? Clin Obstet Gynecol 43(1):32–45CrossRefPubMed

Lapolla A, Dalfrà MG, DiCianni G, Bonomo M, Parretti E, Mello G (2008) A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr Metab Cardiovasc Dis 18(4):291–297CrossRefPubMed

Mills JL, Baker L, Goldman AS (1979) Malformations in infants of diabetic mothers occur before the seventh gestational week Implications for treatment. Diabetes 28(4):292–293CrossRefPubMed

Ray IG, Brien OTE, Chan WS (2001) Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. Q J Med 94:435–444

Reece EA, Eriksson UJ (2004) Congenital malformations: epidemiology, pathogenesis and experimental methods of induction and prevention. Diabetes in women: adolescence, pregnancy and menopause, 3rd edn. Lippincott Williams and Wilkins Philadelphia, Philadelphia, pp 169–204

Holing EV, Beyer CS, Brown ZA, Connell FA (1998) Why don’t women with diabetes plan their pregnancies? Diabetes Care 21(6):889–895CrossRefPubMed

Janz NK, Herman WH, Becker MP (1995) Diabetes and pregnancy: factors associated with seeking preconception care. Diabetes Care 18:157–165CrossRefPubMed

Kitzmiller JL, Block JM, Brown FM et al (2008) Managing pre-existing diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 31(5):1060–1079CrossRefPubMed

10.

Diabetes in pregnancy, management of diabetes and its complications from preconception to the postnatal period. National Collaborating Centre for Women’s and Children’s Health. March 2008

11.

Global Guidelines for Diabetes in Pregnancy (2009) International Diabetes Federation

12.

Cheung NW, Conn JJ, d’Emden MC et al (2009) Position statement of the Australian diabetes society: individualisation of glycated haemoglobin targets for adults with diabetes mellitus. Med J Aust 191(6):339–344PubMed

13.

Ylinen K, Aula P, Stenman UH, Kesäniemi-Kuokkanen T, Teramo K (1984) Risk of minor and major fetal malformations in diabetics with high haemoglobin A1c values in early pregnancy. Br Med J 289(6441):345–346CrossRef

14.

Towner D, Kjos SL, Leung B et al (1995) Congenital malformations in pregnancies complicated by NIDDM. Diabetes Care 18(11):1446–1451CrossRefPubMed

15.

Lapolla A, Dalfrà MG, Fedele D (2008) Pregnancy complicated by type 2 diabetes: an emerging problem. Diabetes Res Clin Pract 80(1):2–7CrossRefPubMed

16.

Pregnancy outcomes in the Diabetes Control, Complication Trial (1996) The diabetes control and complication trial research group. Am J Obstet Gynecol 174:1343–1353CrossRef

17.

Suhonen L, Hiilesmaa V, Teramo K (2000) Glycaemic control during early pregnancy and fetal malformations in women with type I diabetes mellitus. Diabetologia 43(1):79–82CrossRefPubMed

18.

Nielsen GL, Møller M, Sørensen HAT (2006) HbA1c in early diabetic pregnancy and pregnancy outcomes: a Danish population-based cohort study of 573 pregnancies in women with type 1 diabetes. Diabetes Care 29(12):2612–2616CrossRefPubMed

19.

Jensen DM, Korsholm L, Ovesen P et al (2009) Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care 32(6):1046–1048CrossRefPubMed

20.

Guerin A, Nisenbaum R, Ray JG (2007) Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with pre-pregnancy diabetes. Diabetes Care 30(7):1920–1925CrossRefPubMed

21.

Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ (2006) Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies. BMC Pregnancy Childbirth 30(6):30CrossRef

22.

The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRef

23.

Rosenn BM, Miodovnik M, Holcberg G, Khoury JC, Siddiqi TA (1995) Hypoglycemia: the price of intensive insulin therapy for pregnant women with insulin-dependent diabetes mellitus. Obstet Gynecol 85(3):417–422CrossRefPubMed

24.

Lapolla A, Dalfrà MG, Lencioni C, Di Cianni G (2008) Hypoglycemia in diabetic pregnancy. In: Hod M, Jovanovic L, DiRenzo GC, deLeiva A, Langer O (eds) Textbook of diabetes and pregnancy, vol 32. Informa Healthcare, UK, p 246

25.

Evers IM, ter Braak EW, de Valk HW, der Schoot B, Janssen N, Visser GHA (2002) Risk indicators predictive for severe hypoglycemia during the first trimester of type 1 diabetic pregnancy. Diabetes Care 25(3):554–559CrossRefPubMed

26.

Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER (2008) Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care 31(1):9–14CrossRefPubMed

27.

Kerssen A, de Valk HW, Visser GH (2006) Do HbA1c levels and the self-monitoring of blood glucose levels adequately reflect glycaemic control during pregnancy in women with type 1 diabetes mellitus? Diabetologia 49(1):25–28CrossRefPubMed

28.

Kerssen A, de Valk HW, Visser GH (2006) Forty-eight-hour first-trimester glucose profiles in women with type 1 diabetes mellitus: a report of three cases of congenital malformation. Prenat Diagn 26(2):123–127CrossRefPubMed

29.

Mosca A, Paleari R, Dalfrà MG et al (2006) Reference intervals for haemoglobin A1c in pregnant women: data from an Italian Multicentric study. Clin Chem 52:1138–1143CrossRefPubMed

30.

Nielsen LR, Ekbom P, Damm P et al (2004) HbA1c levels are significantly lower in early and late pregnancy. Diabetes Care 27(5):1200–1201CrossRefPubMed

31.

Jeppsson JO, Kolbold U, Barr J et al (2002) Approved IFCC reference method for the measurement of HbA1c in human blood. Clin Chem Lab Med 40:78–89CrossRefPubMed

32.

Larciprete G, Valensise H, Vasapollo B et al (2003) Maternal body composition at term gestation and birth weight: is there a link? Acta Diabetol 40:S222–S224CrossRefPubMed

33.

Valensise H, Larciprete G, Arduini D, De Lorenzo D (2003) The fetal body compartments and their detection during pregnancy. Acta Diabetol 40:S79–S82CrossRefPubMed

34.

Lapolla A, Dalfrà MD MG, Masin M et al (2003) Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional therapy. Acta Diabetol 40:143–149CrossRefPubMed

35.

Gimenez M, Conget T, Nicolau J, Pericot A, Levy I (2007) Outcome of pregnancy in women with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion or conventional therapy. A case control study. Acta Diabetol 44:34–37CrossRefPubMed

36.

Lapolla A, Dafrà MG, Spezia R et al (2008) Outcome of pregnancy in type 1 diabetic patients treated with insulin lispro or regular insulin: an Italian experience. Acta Diabetol 45(1):61–66CrossRefPubMed

37.

Torlone E, Di Cianni G, Mannino D, Lapolla A (2009) Insulin analogs and pregnancy: an update. Acta Diabetol 46(3):163–172CrossRefPubMed

Titel: Pregnancy complicated by diabetes: what is the best level of HbA1c for conception?
verfasst von: Annunziata Lapolla
Maria Grazia Dalfrà
Domenico Fedele
Publikationsdatum: 01.09.2010
Verlag: Springer Milan
Erschienen in: Acta Diabetologica / Ausgabe 3/2010
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-010-0199-z

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