Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes.
Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes.
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DOI：
10.1111/dme.14789
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发表时间：
2022-05
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影响因子：
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探讨母亲对低血糖的恐惧、低血糖意识受损和正常妇女的血糖和妊娠结局。参加CONCEPTT试验的214名1型糖尿病孕妇的预先计划亚研究。参与者在基线时完成低血糖恐惧调查（HFS‐II）。使用Logistic回归和泊松回归分析来获得与严重低血糖发作次数相关的认知率比率的调整估计，以及与HFS - II总评分相关的几个新生儿结局。研究了连续血糖监测（CGM）的作用。总体而言，30%的参与者报告低血糖意识受损（n = 64）。低血糖意识受损的女性（妊娠12-34周）有更多的严重低血糖发作（平均0.44比0.08,p < 0.001），并且在HFS - II量表上得分更高（43.7比36.0,p < 0.008），表明更害怕低血糖。在妊娠12周时，它们的血糖低于正常范围（CGM <3.5 mmol/L）的时间更长，血糖变异性更大。总体HFS - II评分越高，母体发生严重低血糖发作的风险越高（比率比1.78,95% CI 1.39-2.27）。低血糖意识受损的孕妇体重增加较少，但低血糖意识受损的孕妇和正常低血糖意识的孕妇在新生儿结局上没有差异。较高的HFS‐II评分与更多的肾病相关（优势比1.91,95% CI 1.06-3.4）。12周后使用CGM与严重低血糖发作次数无关（RR 0.75, 95% CI 0.49-1.15; p = 0.18）。在患有1型糖尿病的孕妇中，对低血糖的认知受损与更多的母体严重低血糖发作和更多的低血糖恐惧有关。对低血糖的认知受损和/或对低血糖的恐惧应提醒临床医生注意这种增加的风险。令人放心的是，新生儿不良结局没有增加。
To examine maternal fear of hypoglycaemia, glycaemia and pregnancy outcomes in women with impaired and normal awareness of hypoglycaemia. A pre‐planned sub‐study of 214 pregnant women with type 1 diabetes who participated in the CONCEPTT trial. Participants completed hypoglycaemia fear surveys (HFS‐II) at baseline. Logistic regression and Poisson regression analyses were used to obtain an adjusted estimate for the rate ratio relating awareness to the number of severe hypoglycaemic episodes, and for several neonatal outcomes in relation to the total HFS‐II score. The role of continuous glucose monitoring (CGM) use was examined. Overall, 30% of participants reported impaired awareness of hypoglycaemia (n = 64). Women with impaired awareness of hypoglycaemia had more episodes of severe hypoglycaemia (mean 0.44 vs. 0.08, p < 0.001) (12–34 weeks gestation) and scored higher on the HFS‐II scale (43.7 vs. 36.0, p 0.008), indicating more fear of hypoglycaemia. They spent more time below range (CGM <3.5 mmol/L) and exhibited more glycaemic variability at 12 weeks gestation. Higher overall HFS‐II scores were associated with a higher risk of maternal severe hypoglycaemia episodes (Rate Ratio 1.78, 95% CI 1.39–2.27). Women with impaired awareness of hypoglycaemia had less maternal weight gain but there were no differences in neonatal outcomes between women with impaired awareness of hypoglycaemia and normal hypoglycaemia awareness. Higher HFS‐II scores were associated with more nephropathy (Odds Ratio 1.91, 95% CI 1.06–3.4). CGM use after 12 weeks was not associated with the number of episodes of severe hypoglycaemia (RR 0.75, 95% CI 0.49–1.15; p = 0.18). In pregnant women with type 1 diabetes, impaired awareness of hypoglycaemia is associated with more maternal severe hypoglycaemia episodes and more fear of hypoglycaemia. Having impaired awareness of hypoglycaemia and/or fear of hypoglycaemia should alert clinicians to this increased risk. Reassuringly, there was no increase in adverse neonatal outcomes.
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DOI：
10.1016/j.numecd.2019.04.009
发表时间：
2019-07-01
影响因子：
3.9
作者：
Rossi, Maria Chiara;Nicolucci, Antonio;Cucinotta, D.
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Briet, Claire
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Feig, Denice S.;Hwee, Jeremiah;Lipscombe, Lorraine L.
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Lipscombe, Lorraine L.