Clinical and biochemical predictors of large for gestational age during pregnancy in women with type 1 diabetes mellitus - current insight.

Objectives: Large for gestational age (LGA) is defined as a birth weight equal to or higher than the 90th centile for a certain gestational age. Despite the efforts to optimize therapeutic goals to stabilize diabetes, there is still a high rate of LGA in type 1 diabetes mellitus (T1DM) mothers. The aim of this paper is a literature review of the data on predictors of LGA incidence in pregnancies complicated by type 1 diabetes mellitus.

Results: Potential LGA predictors in pregestational diabetes include glucose concentration during pregnancy, maternal age, diabetes duration, increased body weight both at the beginning of gestation and at the time of delivery, as well as the weight gain in pregnancy. LGA risk is also associated with the use of an insulin pump (CSII), especially without the support of a continuous glucose monitoring system (CGMS). Significant glycaemic control parameters among others include average fasting glycaemia in the 3rd trimester, HbA1c in the 1st and 3rd trimesters, and among CGMS parameters - shorter TIR (time in range), shorter TBR (time below range) in the 2nd and 3rd trimesters, longer TAR (time above range) > 140 and average glycaemia in each trimester of gestation.

Conclusions: There is still a need for identification of new predictors and theraputic goals in pregnancy in T1DM women to reduce the prevalence of LGA newborns.