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Characterizing maternal glycemic control: a more informative approach using semiparametric regression.

by Miodovnik, Menachem.
Citation: Journal of Maternal-Fetal & Neonatal Medicine. 25(1):15-9, 2012 Jan..Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.ISSN: 1476-4954.Full author list: Vandyke R; Ren Y; Sucharew HJ; Miodovnik M; Rosenn B; Khoury JC.UI/PMID: 21955072.Subject(s): Birth Weight | *Blood Glucose/an [Analysis] | *Diabetes Mellitus, Type 1/bl [Blood] | Female | Fetal Macrosomia/bl [Blood] | Gestational Age | Humans | Pregnancy | *Pregnancy in Diabetics/bl [Blood] | *Regression AnalysisInstitution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tDigital Object Identifier: http://dx.doi.org/10.3109/14767058.2012.626922 (Click here) Abbreviated citation: J Matern Fetal Neonatal Med. 25(1):15-9, 2012 Jan.Local Holdings: Available online through MWHC library: 2013 to the present.Abstract: OBJECTIVE: To characterize glucose concentrations measured throughout pregnancy in women with type 1 diabetes using semiparametric regression analysis to examine the gestational time-specific association with fetal outcome.Abstract: METHODS: We conducted a secondary analysis of data from an interdisciplinary program of diabetes in pregnancy of women with type 1 diabetes. Semiparametric regression was used to characterize glucose concentrations measured using reflectance meters throughout pregnancy by examining the time-specific association of maternal glucose with delivery of a large for gestational age (LGA) baby.Abstract: RESULTS: The optimal model demonstrated that time-specific differences in glycemic profiles of mothers who had LGA versus AGA babies 130912d at various rates across gestation (p=0.0007). AGA glucose profiles exceeded LGA profiles in the first trimester and mid pregnancy; conversely LGA glucose profiles exceeded AGA profiles initially during the third trimester. Differences were based on examination of 95% simultaneous confidence bands.Abstract: CONCLUSIONS: Semiparametric regression techniques enabled synchronous inclusion of all glucose concentrations using multi-step modeling. We identified specific periods of gestation where maternal glucose concentrations differ for the LGA and AGA developing fetus, with greatest distinctions appearing in first and third trimesters. Novel statistical approaches that examine time-specific behavior garner insight into longitudinal assessment of maternal glycemic control.

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