Endocrine Abstracts

Birthweight of HNF1A-affected offspring is largely similar to the background population with rarely reported cases of large for gestational age (LGA) and neonatal hypoglycaemia (NH). Conventional clinical management for pre-gestational diabetes appears sufficient in managing HNF1A-affected women in pregnancy. We aimed to evaluate pregnancy outcomes and review glucose management in HNF1A-affected pregnancies and compare outcomes in offspring of maternal and paternal cases. Obstetric history was recorded at MODY study screening and reviewed at follow up visits. Antenatal variables included pregnancy planning, glycaemic treatment and doses, capillary glucose readings, HbA1c, fructosamine and gestational weight gain. Neonatal variables were birthweight, gestation, mode of delivery, incidence of neonatal hypoglycemia (NH) and offspring diabetes status. 217 pregnancies were included with a live birth rate of 85.2% in the maternal group. Maternal offspring were heavier than paternal cases (75th centile (40-95) vs. 40th centile (21.5-63), P < 0.001). NH was more prevalent in pregnancies affected by maternal dysglycemia (13 infants vs. 0 infants, P = 0.003). There was an increased rate of LGA (P = 0.006) and LSCS (P = 0.002) in offspring of insulin treated pregnancy compared to diet control. There was no significant difference in rates of NH (P = 0.321). Weight adjusted total daily dose of insulin was 0.61unit/kg/day (0.49-0.62) in trimester 3 (n = 26). LGA and NH can occur in HNF1A offspring although these sequelae are less frequent and less severe in paternally inherited cases. Relevant obstetric and neonatal teams should be aware of perinatal concerns to reduce potential morbidity. Prospective studies of glibenclamide in early pregnancy are warranted.