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Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

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Title: Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy
Authors: Morikawa, Mamoru Browse this author →KAKEN DB
Kato-Hirayama, Emi Browse this author
Mayama, Michinori Browse this author
Saito, Yoshihiro Browse this author
Nakagawa, Kinuko Browse this author
Umazume, Takeshi Browse this author →KAKEN DB
Chiba, Kentaro Browse this author
Kawaguchi, Satoshi Browse this author
Okuyama, Kazuhiko Browse this author →KAKEN DB
Watari, Hidemichi Browse this author →KAKEN DB
Issue Date: 16-Mar-2020
Publisher: PLOS
Journal Title: PLoS ONE
Volume: 15
Issue: 3
Start Page: e0230488
Publisher DOI: 10.1371/journal.pone.0230488
Abstract: Pregnant women with diabetes mellitus (DM) are at high risk for hypertensive disorder of pregnancy (HDP). Women with poor control DM sometimes have heavy-for-dates infants. However, women with HDP sometimes have light-for-dates infants. We aim to clarify the relationship between glycemic control and fetal growth in women with DM and/or subsequent HDP. Of 7893 women gave singleton birth at or after 22 gestational weeks, we enrolled 154 women with type 1 DM (T1DM) or type 2 DM (T2DM) whose infants did not have fetal abnormalities. Among women with T1DM or T2DM, characteristics of the three groups (with HDP, without HDP, and with chronic hypertension [CH]) were compared. No women with T1DM had CH, but 19 (17.4%) of 109 with T2DM did. HDP incidence was similar between women with T1DM (22.2%) and T2DM without CH (16.7%). Among women with T1DM, the incidences of fetal growth restriction (FGR) with and without HDP were similar. However, among women with T2DM without CH, this incidence was significantly higher among those with HDP (33.3%) than among those without HDP (5.3%), was significantly more common with HbA1c levels at first trimester. 7.2% (33.3%) than with those < 7.2% (5.6%), and significantly more numerous without pre-pregnancy therapies for DM (23.3%) than with them (3.3%). Among women with T2DM and HDP, those with FGR had smaller placenta SDs and higher insulin dosages at delivery than those without light-for-dates. In multivariate analysis, the presence of diabetic nephropathy was a predictor of T1DM and HDP (P = 0.0105), whereas HbA1c levels >= 7.2% before pregnancy was a predictor of T2DM and HDP (P = 0.0009). Insulin dosage > 50U/day at delivery (P = 0.0297) and the presence of HDP (P = 0.0116) independently predicted T2DM, HDP, and FGR development. Insufficient pre-pregnancy treatment of DM increased the risk of HDP.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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