Diabetes control and pregnancy outcomes in women with type 1 diabetes treated during pregnancy with continuous subcutaneous insulin infusion or multiple daily insulin injections

Abstract

Objectives. The aim of the study was to compare diabetes control and obstetrical outcomes in pregnant women with type 1 diabetes treated during pregnancy with either continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDII). Patients and methods. It was a descriptive, retrospective, observational study of 116 Caucasian pregnant women with type 1 diabetes mellitus. Thirty women were treated during pregnancy with continuous subcutaneous insulin infusion (CSII group) and 86 with multiple daily insulin injections (MDII group). Results. Mean age and body mass index did not differ between groups (p >0.05). Duration of diabetes was longer in CSII than in MDII group, 12.7 ±7.20 vs. 7.71 ±6.13 years, respectively (p = 0.0005). There were no differences between the studied groups in glycated hemoglobin (HbA 1c) levels in the I, II and III trimesters of pregnancy-in CSII group 7.41 ±1.75, 6.57 ±1.09 and 6.46 ±0.87, respectively, in MDII group-7.71 ±2.37, 6.65 ±1.18 and 6.75 ±1.21, respectively (p >0.05). There were no severe hypoglycemia and diabetic coma. Mean duration of pregnancy, rate of premature deliveries, newborn birth weight, incidence of SGA and LGA, and the frequency of neonatal hypoglycemia did not differ between groups (p >0.05). The total malformation rate was 5.13%, including 2 terminated pregnancies and the frequency did not differ between groups (p >0.05). The rate of spontaneous abortions was 16.7% in CSII group and 10.3% in MDII (p >0.05). Conclusions. No apparent relationships between mode of insulin therapy and pregnancy outcome were found in type 1 diabetes patients.

Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

“…[51][52][53]56 The investigators did not find any studies in pregnant women with T1DM that evaluated maternal mortality, microvascular or macrovascular disease, quality of life, any of the process measures, or birth trauma, and no studies were identified that compared the effectiveness of CSII and MDI in pregnant women with pre-existing T2DM.…”

“…Also, meta-analyses of retrospective studies showed nonsignificant relative risks for rates of C-section (RR = 1.01; 95% CI, 0.86-1.20), [53][54][55][56] severe hypoglycemia (RR = 0.78; 95% CI, 0.23-2.65), [54][55][56] admission to the neonatal intensive care unit (RR = 0.84; 95% CI, 0.43-1.68), 54,55 pre-term delivery (RR = 0.98; 95% CI, 0.67-1.43), [53][54][55][56] and frequency of neonatal hypoglycemia (RR = 1.01; 95% CI, 0.86-1.20). [53][54][55][56] Additionally, metaanalyses for major congenital anomalies showed a pooled RR of 2.12 that favored MDI but was not statistically significant. 55,56 Due to the lack of RCTs, which leads to a high risk of bias of all the above outcomes, the EPC investigators suggested that results were inconclusive.…”

“…and fetal outcomes. [51][52][53][54][55][56] The mean age of study participants was 26 to 31 years, with most participants in the CSII group enrolled into the studies prior to becoming pregnant. Most participants had diabetes duration of 7.7 to 13.9 years, with participants in the CSII groups having the longest duration of diabetes.…”

“…[51][52][53][54][55][56] The strength of evidence of the data that compared CSII with MDI among pregnant women with pre-existing T1DM was insufficient for all other maternal and neonatal outcomes due to lack of RCTs and, therefore, a high risk of bias. There was no statistical difference in maternal weight gain, 52,54,56 gestational age at delivery, 51,[53][54][55] birth weight, [53][54][55] and minor congenital anomalies 51,54 between the CSII and MDI intervention groups.…”

“…[51][52][53][54][55][56] The strength of evidence of the data that compared CSII with MDI among pregnant women with pre-existing T1DM was insufficient for all other maternal and neonatal outcomes due to lack of RCTs and, therefore, a high risk of bias. There was no statistical difference in maternal weight gain, 52,54,56 gestational age at delivery, 51,[53][54][55] birth weight, [53][54][55] and minor congenital anomalies 51,54 between the CSII and MDI intervention groups. Also, meta-analyses of retrospective studies showed nonsignificant relative risks for rates of C-section (RR = 1.01; 95% CI, 0.86-1.20), [53][54][55][56] severe hypoglycemia (RR = 0.78; 95% CI, 0.23-2.65), [54][55][56] admission to the neonatal intensive care unit (RR = 0.84; 95% CI, 0.43-1.68), 54,55 pre-term delivery (RR = 0.98; 95% CI, 0.67-1.43), [53][54][55][56] and frequency of neonatal hypoglycemia (RR = 1.01; 95% CI, 0.86-1.20).…”