Diabetologia · 2025
Pregnancy and neonatal outcomes in women with GCK-MODY: an observational study based on standardised insulin modalities.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Ciangura Cécile, Seco Aurélien, Saint-Martin Cécile, Ancel Pierre-Yves, Bouvet Delphine, Jacqueminet Sophie, Hartemann Agnès, Lepercq Jacques, Nizard Jacky, Timsit José, Bellanné-Chantelot Christine, Monogenic Diabetes Study Group of the Société Francophone du Diabète
Аннотация
AIMS/HYPOTHESIS: The management of GCK-MODY during pregnancy remains challenging. We evaluated the impact on pregnancy and neonatal outcomes of two standardised insulin strategies.
METHODS: In this prospective observational study, participants chose (in agreement with their physician) to be treated with insulin either when maternal capillary blood glucose (CBG) ≥ thresholds for gestational diabetes (5.3 mmol/l before or 6.7 mmol/l 2 h after meals) (MG group) or when fetal abdominal circumference ≥75th percentile (FG group). In the FG group, insulin was also initiated if CBG ≥ safety levels (6.7 mmol/l before meals or 11.1 mmol/l 2 h after meals). Data on glycaemic management, modalities and timing of insulin therapy and maternal and neonatal outcomes were recorded.
RESULTS: In the MG group (n=25), insulin was initiated more frequently (100% vs 75%, p=0.01) and earlier (p=0.001), with lower CBG and more frequent hypoglycaemic episodes compared with the FG group (n=21). However, there were no differences in pregnancy and neonatal outcomes. In the total cohort, the rate of large for gestational age (LGA) neonates, preterm deliveries and Caesarean sections was 22.2%, 2.2% and 40%, respectively. The rate of LGA was 0% among the neonates with the GCK variant vs 36% in those without (p=0.005). There were no associations between LGA and pregnancy characteristics, insulin therapy strategy or glycaemic management.
CONCLUSIONS/INTERPRETATION: In our study, the rate of LGA primarily depended on the fetal GCK genotype rather than the treatment strategy or glycaemic management. Our results suggest that a standardised strategy based on ultrasound monitoring of fetal growth and glycaemic safety thresholds, leading to delayed insulin initiation, offers a good fetal prognosis and minimises the risk of maternal hypoglycaemia.
TRIAL REGISTRATION: ClinTrials.gov NCT02556840.
METHODS: In this prospective observational study, participants chose (in agreement with their physician) to be treated with insulin either when maternal capillary blood glucose (CBG) ≥ thresholds for gestational diabetes (5.3 mmol/l before or 6.7 mmol/l 2 h after meals) (MG group) or when fetal abdominal circumference ≥75th percentile (FG group). In the FG group, insulin was also initiated if CBG ≥ safety levels (6.7 mmol/l before meals or 11.1 mmol/l 2 h after meals). Data on glycaemic management, modalities and timing of insulin therapy and maternal and neonatal outcomes were recorded.
RESULTS: In the MG group (n=25), insulin was initiated more frequently (100% vs 75%, p=0.01) and earlier (p=0.001), with lower CBG and more frequent hypoglycaemic episodes compared with the FG group (n=21). However, there were no differences in pregnancy and neonatal outcomes. In the total cohort, the rate of large for gestational age (LGA) neonates, preterm deliveries and Caesarean sections was 22.2%, 2.2% and 40%, respectively. The rate of LGA was 0% among the neonates with the GCK variant vs 36% in those without (p=0.005). There were no associations between LGA and pregnancy characteristics, insulin therapy strategy or glycaemic management.
CONCLUSIONS/INTERPRETATION: In our study, the rate of LGA primarily depended on the fetal GCK genotype rather than the treatment strategy or glycaemic management. Our results suggest that a standardised strategy based on ultrasound monitoring of fetal growth and glycaemic safety thresholds, leading to delayed insulin initiation, offers a good fetal prognosis and minimises the risk of maternal hypoglycaemia.
TRIAL REGISTRATION: ClinTrials.gov NCT02556840.