Associations of hyperglycemic emergency and severe hypoglycemia incidences with seasonality and ambient temperature among pregnant women with diabetes: a nested case-control study in Taiwan.

Wen-hsuan Hou; Jia-ling WU; Chin-li LU; Lilis Sulistyorini; Muhammad Atoillah Isfandiari; Chang-ta Chiu; Chung-yi LI

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Associations of hyperglycemic emergency and severe hypoglycemia incidences with seasonality and ambient temperature among pregnant women with diabetes: a nested case-control study in Taiwan.

Author: Wen-Hsuan HOU ¹ ; Jia-Ling WU ² ; Chin-Li LU ³ ; Lilis SULISTYORINI ⁴ ; Muhammad Atoillah ISFANDIARI ⁵ ; Chang-Ta CHIU ⁶ ; Chung-Yi LI ²
Author Information

1. Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital.
2. Department of Public Health, College of Medicine, National Cheng Kung University.
3. Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University.
4. Department of Environmental Health, Faculty of Public Health, Universitas Airlangga.
5. Department of Epidemiology, Faculty of Public Health, Universitas Airlangga.
6. Department of Dentistry, An Nan Hospital, China Medical University.
Publication Type:Journal Article
Keywords: Case-control studies; Pregnancy complications; Pregnancy in diabetes; Seasonal variation; Temperature
MeSH: Case-Control Studies; Diabetes Mellitus, Type 1/complications*; Female; Humans; Hypoglycemia/etiology*; Incidence; Pregnancy; Pregnant Women; Taiwan/epidemiology*; Temperature
From:Environmental Health and Preventive Medicine 2022;27(0):11-11
CountryJapan
Language:English
Abstract: BACKGROUND:Associations of acute glycemic complications with season and ambient temperature have been reported in general population with diabetes. However, little is known about the risks of acute glycemic complications in relation to season and ambient temperature in pregnant women, who are likely to be even more vulnerable. This work aimed to investigate the associations of season and ambient temperature with pregnancies complicated with hyperglycemia emergency or severe hypoglycemia.
METHODS:Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and "length of gestation at risk" (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008-2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date.
RESULTS:Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08-2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97-3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications.
CONCLUSIONS:A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM.