{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:51:53Z","timestamp":1753890713607,"version":"3.41.2"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Double diabetes (DDiab) is defined as T1DM coexisting with insulin resistance (IR), metabolic syndrome (MetS), and\/or obesity. Little evidence is available regarding how frequent DDiab is among T1DM pregnancies and whether it affects the perinatal outcome in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims of the study<\/jats:title><jats:p>To explore the prevalence of DDiab in early pregnancy in the cohort of pregnant women with T1DM and to examine the association between an early-pregnancy DDiab status and fetomaternal complications characteristic for T1DM in pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A retrospective data analysis of the multicenter cohort of N=495 pregnant women in singleton pregnancy complicated with T1DM followed from early pregnancy until delivery in three tertiary referral centers. DDiab status was defined as T1DM plus pre-pregnancy obesity defined as BMI\u226530 kg\/m<jats:sup>2<\/jats:sup> measured at the first antenatal visit (DDiabOb), or T1DM plus pre-pregnancy IR defined as eGDR (estimated Glucose Disposal Rate) below the 25<jats:sup>th<\/jats:sup> centile for the cohort measured at the first antenatal visit (DDiabIR). Proportions of the adverse pregnancy outcomes were compared between DDiabOb and Non-DDiabOb and between DDiabIR and Non-DDiabIR patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Characteristics of the study group<\/jats:title><jats:p>(data presented as mean(SD) or percentage): age: 30.0(5.1) years; age when T1DM diagnosed: 17.5(8.5) years; T1DM duration: 12.0(7,9) years; microvascular complications (White classes R,F,RF): 11.9%, pre-pregnancy counselling: 26.6%, baseline gestational age: 10.5(4.3) weeks, pre-pregnancy BMI: 23.7(4.3) kg\/m<jats:sup>2<\/jats:sup>; chronic hypertension: 9.1%, gestational hypertension (PIH) 10.7%, preeclampsia (PET): 3.2%; nulliparity 53.8%, smoking in pregnancy: 4.8%, eGWG: 22.4%, DDiabOB: 10.1%; DdiabIR: 25.2%; LGA: 44.0%, and NICU admission: 20.8%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>(data from the univariate analysis given as OR(95%CI)): both DDiabOB and DDiabIR status increased the risk for eGWG [23.15 (10.82; 55.59); 3.03 (1.80; 5.08), respectively]. DDiabIR status increased the risk for PET [4.79 (1.68;14.6)], preterm delivery [1.84 (1.13; 3.21)], congenital malformation [2.15 (1.07;4.25)], and NICU hospitalization [2.2 (1.20;4.01)]. Both DDiabOB and DDiabIR accurately ruled out PET (NPV 97.3%\/98.3%, accuracy: 88.3%\/75.6%, respectively), congenital malformation (NPV 85.6%\/88.4%, accuracy: 78.9\/69.8, respectively), and perinatal mortality (NPV 98.7%\/99.2%, accuracy: 88.8%\/74.5%, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Double diabetes became a frequent complication in T1DM pregnant population. Double diabetes diagnosed in early pregnancy allows for further stratification of the T1DM pregnant population for additional maternal risk. <\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1215407","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T18:07:27Z","timestamp":1690567647000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Double diabetes as an effect modifier for adverse perinatal outcome in pregnant women with type 1 diabetes mellitus \u2013 a retrospective multicenter cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Aneta","family":"Malinowska-Polubiec","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnieszka","family":"Zawiejska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewa","family":"Romejko-Wolniewicz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grzegorz","family":"Poprawski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iwona","family":"Towpik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Br\u0105zert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuzanna","family":"Handziuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krzysztof","family":"Czajkowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13848","article-title":"Double diabetes: A distinct high-risk group","volume":"21","author":"Kietsiriroje","year":"2019","journal-title":"Diabetes Obes Metab"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S223618","article-title":"Obesity in patients with type 1 diabetes: links, risks and management challenges","volume":"14","author":"Vilarrasa","year":"2021","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B3","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1111\/j.1467-789X.2008.00541.x","article-title":"Pre-pregnancy BMI nd risk of gestational diabetes: a systematic review of Literature with meta-analysis","volume":"10","author":"Torloni","year":"2009","journal-title":"Obes Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1001\/jama.2017.16191","article-title":"Association between pre-pregnancy body mass index and severe maternal morbidity","volume":"318","author":"Lisonkova","year":"2017","journal-title":"JAMA"},{"key":"B5","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1111\/1471-0528.15661","article-title":"Impact of maternal mbody mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North America and Australian cogorts","volume":"126","author":"Santos","year":"2019","journal-title":"BJOG"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1007\/s10995-010-0689-1","article-title":"Predictors of obesity in childhood, adolescence, and adulthood in birth cohort","volume":"15","author":"Roonney","year":"2011","journal-title":"Matern Child Health J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1007\/s10654-015-0085-7","article-title":"Maternal obesity during pregnancy and cardiovascular development and disease in the offspring","volume":"30","author":"Gaillard","year":"2015","journal-title":"Eur J Epidemiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e000601","DOI":"10.1136\/bmjopen-2011-000601","article-title":"Pre-pregnancy body mass index and the risk of adverse outcome in type 1 diabetic pregnancies: a population-based study","volume":"2","author":"Persson","year":"2012","journal-title":"BMJ Open"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2627-9","article-title":"Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989-2008","volume":"55","author":"Klemetti","year":"2012","journal-title":"Diabetologia"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.5694\/mja16.00443","article-title":"Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycemic control","volume":"205","author":"Abell","year":"2016","journal-title":"Med J Aust"},{"key":"B11","article-title":"Metabolic syndrome in type 1 diabetes mellitus. Does it have any impact on the course of pregnancy","volume":"62","author":"Wender-Ozegowska","year":"2011","journal-title":"J Physiol Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.49.4.626","article-title":"Can clinical factors estimate insulin resistance in type 1 diabetes","volume":"49","author":"Williams","year":"2000","journal-title":"Diabetes"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1693","article-title":"Use of the estimated glucose disposal rate as a measureof insulin resistance in an urban multiethnic population with type1 diabetes","volume":"36","author":"Epstein","year":"2013","journal-title":"Diabetes Care"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13110","article-title":"Esti-mated glucose disposal rate predicts mortality in adults with type1 diabetes","volume":"20","author":"Nystr\u00f6m","year":"2018","journal-title":"Diabetes Obes Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000437382.03963.88","article-title":"Report of the American College of Obstetricians and Gynecologists\u2019 Task Force on hypertension in pregnancy","volume":"122","year":"2013","journal-title":"Obstet Gynecol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e003423","DOI":"10.1136\/bmjgh-2020-003423","article-title":"Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data","volume":"5","author":"Wang","year":"2020","journal-title":"BMJ Glob Health"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project","volume":"384","author":"Villar","year":"2014","journal-title":"Lancet"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e14529","DOI":"10.1111\/dme.14529","article-title":"Body mass index, estimated glucose disposal rate and vascular complications in type 1 diabetes: Beyond glycated haemoglobin","author":"Helliwell","year":"2021","journal-title":"Diabetic Med"},{"volume-title":"R: A language and environment for statistical computing","year":"2022","key":"B19"},{"key":"B20","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.siny.2008.09.002","article-title":"Obesity, gestational diabetes and pregnancy outcome","volume":"14","author":"Yogev","year":"2009","journal-title":"Semin Fetal Neonatal Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1001321","DOI":"10.1371\/journal.pmed.1001321","article-title":"Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study","volume":"9","author":"Livingstone","year":"2012","journal-title":"PloS Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2006.01847.x","article-title":"Weight gain is associated with improved glycaemic control but with ad- verse changes in plasma lipids and blood pressure in type 1 diabetes","volume":"23","author":"Ferriss","year":"2006","journal-title":"Diabetes Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.2.140","article-title":"Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT","volume":"280","author":"Purnell","year":"1998","journal-title":"Diabetes Control Complications Trial JAMA"},{"key":"B24","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/s12884-021-03809-2","article-title":"Epidemiological trends of maternal hypertensive disorders at the global, regional and national levels: a population-based study","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.31083\/j.ceog.2021.03.2413","article-title":"Gestational weight gain and long-term postpartum weight retention","volume":"48","author":"Berezowsky","year":"2021","journal-title":"Clin Exp Obstet Gynecol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9123795","article-title":"Excessive gestational weight gain: long-term consequences for the child","volume":"9","author":"Baran","year":"2020","journal-title":"J Clin Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2018.00713","article-title":"Assessing the impact of excessive gestational weight gain among women with type 1 diabetes on overweight\/obesity in their adolescent and young adult offspring: A pilot study","volume":"9","author":"McWhorter","year":"2018","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s12902-020-00570-z","article-title":"Comparison of indirect markers of insulin resistance in adult patients with Double Diabetes","volume":"20","author":"Ferreira-Hermosillo","year":"2020","journal-title":"BMC Endocr Disord"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-013-2904-2","article-title":"Insulin resistance in type 1 diabetes: what is \u2018double diabetes\u2019 and what are the risks","volume":"56","author":"Cleland","year":"2013","journal-title":"Diabetologia"},{"key":"B30","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1186\/s12902-021-00851-1","article-title":"The association between overweight\/obesity and double diabetes in adults with type 1 diabetes; a cross-sectional study","volume":"21","author":"Cantley","year":"2021","journal-title":"BMC Endocr Disord"},{"key":"B31","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1038\/s41387-019-0101-1","article-title":"Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors","volume":"9","author":"Khawandanah","year":"2019","journal-title":"Khawandanah Nutr Diabetes"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2023.1215407\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T18:07:30Z","timestamp":1690567650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2023.1215407\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,28]]},"references-count":31,"alternative-id":["10.3389\/fendo.2023.1215407"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2023.1215407","relation":{},"ISSN":["1664-2392"],"issn-type":[{"type":"electronic","value":"1664-2392"}],"subject":[],"published":{"date-parts":[[2023,7,28]]},"article-number":"1215407"}}