Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

Claire L Meek, Rosa Corcoy, Elizabeth Asztalos, Laura C Kusinski, Esther López, Denice S Feig, Helen R Murphy, CONCEPTT collaborative group, Denice S Feig, Helen R Murphy, Elisabeth Asztalos, Jon F R Barrett, Rosa Corcoy, Alberto de Leiva, Lois E Donovan, J Moshe Hod, Lois Jovanovic, Erin Keely, Craig Kollman, Ruth McManus, Kellie E Murphy, Katrina Ruedy, George Tomlinson, Claire L Meek, Rosa Corcoy, Elizabeth Asztalos, Laura C Kusinski, Esther López, Denice S Feig, Helen R Murphy, CONCEPTT collaborative group, Denice S Feig, Helen R Murphy, Elisabeth Asztalos, Jon F R Barrett, Rosa Corcoy, Alberto de Leiva, Lois E Donovan, J Moshe Hod, Lois Jovanovic, Erin Keely, Craig Kollman, Ruth McManus, Kellie E Murphy, Katrina Ruedy, George Tomlinson

Abstract

Background: Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).

Methods: This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres ( ClinicalTrials.gov NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome.

Results: Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62, 67 and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2, 1.3 and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born > 97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes.

Conclusions: GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.

Trial registration: This trial is registered with ClinicalTrials.gov . number NCT01788527 . Trial registered 11/2/2013.

Keywords: Birth-weight; CONCEPTT; Diabetes; GROW; Growth standards; INTERGROWTH; Large-for-gestational-age; Macrosomia; Pregnancy; Small for gestational age.

Conflict of interest statement

Denice Feig has received honoraria for speaking engagements from Medtronic and has been on an.

Helen Murphy has received honoraria for speaking engagements from Medtronic, Roche, Novo Nordisk, Eli-Lilly and is a member of the Medtronic European Advisory Board.

CLM is the guarantor of this work and, as such, has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Fig. 1
Fig. 1
Rates (%) of caesarean delivery, preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, NICU admission and the composite neonatal outcome according to birth centile category based on GROW, INTERGROWTH and WHO standards. Numbers in each category are given at the bottom right of this figure

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