ABSTRACT. Laatikainen L, Teramo K, Hieta‐Heikurainen H, Koivisto V, Pelkonen R (Department of Ophthalmology, I and II Departments of Obstetrics and Gynaecology, III Department of Medicine, Helsinki University Hospital, Helsinki, Finland). A controlled study of the influence of continuous subcutaneous insulin infusion treatment on diabetic retinopathy during pregnancy.
Forty consecutive pregnant patients with insulin‐dependent (Type I) diabetes mellitus were randomized at the end of the first trimester for treatment with conventional insulin therapy (CIT) or continuous subcutaneous insulin infusion therapy (CSII). Nine patients randomized into the CSII group declined the pump treatment. The mean glycosylated haemoglobin (Hb A1c) decreased (p<0.001) both in the CIT and the CSII groups with no difference between the groups. Some deterioration in retinopathy was found in 2/18 patients in the CIT group, in 5/13 in the CSII group, and in 3/9 of those who declined the pump treatment. The proportion of patients whose retinopathy progressed did not differ significantly between the groups, and in the majority the deterioration was mild. However, two patients in the CSII group developed acute ischaemic retinopathy, which progressed to proliferative stage in spite of laser treatment. In these two cases the decrease in the Hb Alc level was among the greatest and fastest in the study. These data suggest that a rapid near normalization of glycaemic control by CSII during pregnancy can accelerate the progress of retinopathy in poorly controlled diabetic patients.
The time of ovulation and conception of 24 insulin-dependent (Type I) diabetic women was estimated by monitoring the basal body temperature (BBT). The mean (+/- SD) duration of the menstrual cycle was 28 (+/- 2) days. Conception occurred, on the average, on the 18th day of the cycle. The fetal crown-rump length was measured by ultrasound scan every 2 weeks between 6 and 14 weeks of pregnancy. When menstrual history was used for dating, there was an apparent early fetal growth delay by a mean of 4 days. When the dates were corrected by BBT, the fetal growth was identical with the standard mean crown-rump length diagram by Robinson & Fleming. The findings of our study suggest that early fetal growth delay reported by Pedersen & Mølsted-Pedersen does not exist in diabetic pregnancy. The small fetuses observed could be explained by an error in the gestational age.
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