Abstract
Introduction When planning the treatment of women with gestational diabetes, the current standard
approach also takes fetal growth development into account. The treatment of pregnant
women with type 1 diabetes mellitus (DM) used to be based exclusively on maternal
blood glucose values. This study investigated the impact of including fetal growth
parameters in the monitoring of pregnant women with type 1 diabetes mellitus.
Patients/Method 199 pregnant women with type 1 DM were included in a cohort study. The patient population
was divided into two study cohorts. In the mBG cohort (n = 94; investigation period:
1994 – 2005) treatment was monitored using only maternal blood glucose (mBG) values;
the aim was to achieve standard target glucose values (mean BG < 5.5 mmol/l, postprandial:
at 1 h < 7.7 mmol/l, at 2 h < 6.6 mmol/l). In the fUS collective (n = 101, investigation
period: 2006 – 2014) fetal growth parameters were additionally included when monitoring
treatment from the 22nd week of gestation, and maternal target glucose values were
then individually adjusted to take account of fetal growth. This study aimed to investigate
the impact of these two different ways of monitoring treatment on perinatal and peripartum
outcomes.
Results 91.4% of all patients were normoglycemic at the time of delivery (HbA1c < 6.7%); 58.9% of patients achieved strict normoglycemia (HbA1c < 5.7%). No differences were found between the two study cohorts (fUS vs. mBG: HbA1c < 6.7%: 93.9 vs. 88.4%, n. s.; mean blood glucose (BG): 5.4 ± 0.6 to 6.6 ± 1.1 vs.
5.9 ± 0.7 to 7.4 ± 1.9 mmol/l, n. s.). Patients from the fUS cohort required significantly
lower weight-adjusted maximum insulin doses (0.9 ± 0.3 vs. 1.0 ± 0.4 IE/kg bodyweight,
p < 0.05). Pregnancy complications occurred significantly less often in the fUS cohort
(preeclampsia: 7.1 vs. 20.9%, p = 0.01; premature labor: 4.0 vs. 23.3%, p < 0.001;
cervical insufficiency: 0.0 vs. 11.6%, p = 0.001), and there were significantly fewer
cases with neonatal hyperbilirubinemia (19.2 vs. 40.7%, p = 0.001). There was no difference
in the rates of LGA infants between the two cohorts (21.2 vs. 24.4%, n. s.).
Conclusion Using maternal blood glucose values combined with fetal growth parameters to monitor
DM treatment allows therapeutic interventions to be individualized and reduces the
risk of maternal and infant morbidity. The metabolism of patients in the fUS cohort
was significantly more stable and there were fewer variations in glucose values. It
is possible that the detected benefits are due to this metabolic stabilization.
Key words diabetes mellitus - blood glucose - sonography - complications of pregnancy - fetal
outcome
