Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

Achong, Naomi; McIntyre, H. David; Callaway, Leonie K.

doi:10.1177/1753495x13516442

Cited by 6 publications

(3 citation statements)

References 126 publications

(156 reference statements)

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“…All these hormones induce maternal insulin resistance and elevate maternal blood glucose levels. Consequently, a physiological hyperglycemia is associated with pregnancy [20,22,24]. Alterations in insulin resistance are crucial for prioritizing the transfer of glucose across the placenta to support fetal growth [19].…”

Section: Hyperglycemiamentioning

confidence: 99%

Pregnancy and diabetic retinopathy

Rashidian

2024

Med Hypothesis Discov Innov Optom

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Background: An increase in the worldwide prevalence of diabetes, especially among younger populations, has led to a higher prevalence of pre-existing diabetes among pregnant women. The precise mechanisms underlying the development or progression of diabetic retinopathy (DR) during pregnancy are not entirely understood. This narrative review incorporates all available data to offer fresh insights into the pathogenesis and mechanisms of the pregnancy-induced development and/or progression of DR. Moreover, the author aims to offer clinical recommendations for DR both before conception and during pregnancy to appropriately counsel these susceptible patients. Methods: A literature search was performed using various combinations of the following keywords: diabetes, pregnancy, diabetic retinopathy, ocular, eye, retina, microangiopathy, mechanism, pathophysiology, hyperglycemia, hypoxia, neovascularization, growth factors, immune system, blood flow, and recommendations. The search was conducted using PubMed/MEDLINE, ISI Web of Science, Scopus, and Google Scholar, and only English articles published from January 1, 2020, to December 31, 2023, involving human participants, were considered. The International Diabetes Federation Diabetes Atlas website was searched for clinical recommendations. Results: Pregnancy-induced hyperglycemia, blood flow changes, growth factors, and the immune system play important roles in the development and progression of DR. Hyperglycemia leads to significant stress on the capillary endothelium through increased glucose flux via the polyol and hexosamine pathways, activation of protein kinase C, and increased formation of advanced glycation end-products. These pathways act in several ways that may lead to increased oxidative stress, inflammation, and vascular blockage. Thus, eye examinations are crucial before, during, and up to 12 months after pregnancy. Individuals with severe non-proliferative and proliferative DR should gradually decrease their blood glucose levels to near-normal levels over a period of 6 months before conception. Statins and medications inhibiting the renin–angiotensin system should be discontinued before pregnancy or at the initial antenatal visit if they are still being used. Retinal examinations should be performed shortly after conception and during the first trimester using tropicamide eye drops and digital imaging. Subsequent examinations should be scheduled based on DR severity at the initial examination. Conclusions: While the precise mechanism underlying the progression of DR during pregnancy remains uncertain, the available literature suggests that pregnancy-induced hyperglycemia, blood flow changes, growth factors, and the immune system play important roles in its development and progression. Pregnant women with diabetic eye manifestations benefit from the expertise of multidisciplinary teams comprising ophthalmologists, diabetologists, and gynecologists to improve both maternal and perinatal outcomes. Moreover, postpartum follow-up requires special attention.

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Section: Hyperglycemiamentioning

confidence: 99%

Pregnancy and diabetic retinopathy

Rashidian

2024

Med Hypothesis Discov Innov Optom

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“…Insulin resistance pregnancy hormones and other factors are thought to interfere with the action of insulin as it binds to the insulin receptor (5). Insulin resistance is a normal phenomenon emerging in the second trimester of pregnancy, which progresses thereafter to levels seen in non-pregnant patients with DMT2.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of uric acid levels as antioxidant during normal pregnancy and pregnancy with complication (diabetes and hypertension)

et al. 2018

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The uric acid is a waste product of the living cell, produced by xanthine oxidase, which contributes up to 60% of the total plasma antioxidant activity in healthy subjects. The study provides data relating serum uric acid, glucose levels and blood hypertension. Seventy nine patients with pregnancy diabetes mellitus, 25 normal healthy with pregnancy, 25 DM patients, and fifty normal healthy persons, where seen from February till July 2017, in Al-Semawa General Hospital, were participated in the study. The results revealed a highly significant difference (P<0.001) in uric acid, glucose level and hypertension in almost pregnancy diabetic patients and DM patients when compared to control group. In conclusion, this study found that pregnancy women at the early development stage of glucose disorders had a significantly of hyperuricemia and in clinical practices, measurement of serum uric acid level may help to identify the risk of hypertension.

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“…6 In non-pregnant women with T1DM, the total insulin requirement approximates 0.5-0.6 units per kg per day, with similar proportions of basal and bolus insulin requirements. 7 However, the rapid gestational weight gain (GWG) during pregnancy and the multiple factors affecting insulin resistance throughout pregnancy-mainly 'diabetogenic' hormones such as oestrogen, progesterone, and hPL but also adipokines such as TNF-α, adiponectin. and leptin 8-make it difficult to establish clear-cut numeric guidelines for insulin supplementation during gestation-specific-intervals.…”

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confidence: 99%

Insulin requirements during pregnancy in women with type 1 diabetes treated with insulin pump

Dori‐Dayan,

Cukierman‐Yaffe,

Zemet

et al. 2024

Diabetes Metabolism Res

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IntroductionInsulin requirement in women with Type 1 diabetes (T1DM) changes throughout pregnancy. The aim of this study was to determine the total change in insulin requirements and the effect of gestational weight gain (GWG) and pre‐gestational BMI on insulin requirements during pregnancy in women with T1DM treated with continuous subcutaneous insulin infusion and continuous glucose monitoring.MethodsThis historical cohort study included all consecutive women with T1DM who were monitored during pregnancy at the high‐risk pregnancy clinic at a tertiary medical center during April 2011–April 2019. One Way Repeated Measures ANOVA with Bonferroni adjustment was conducted to compare the effects of gestational age on insulin requirements and a Two Way Repeated Measures ANOVA was employed to test for the interaction between gestational age intervals and maternal BMI and GWG.ResultsData regarding insulin requirements of 185 pregnancies were included in the analyses. There was a significant effect of gestational age on total insulin (Wilks' Lambda = 0.34, F(6,14) = 4.52, p = 0.009), basal insulin (Wilks' Lambda = 0.41, F(6,14) = 3.30, p = 0.031) and bolus insulin (Wilks' Lambda = 0.43, F(6,14) = 3.02, p = 0.041). Total insulin/kg requirements increased by 5.5% from 13–20 weeks to 20–26 weeks, 19% from 20–26 weeks to 26–33 weeks, and 17.4% from 26 to 33 weeks to delivery (p for trend = 0.009). Overall, insulin requirements increased by 42.1% from conception to delivery (p < 0.01).There was no significant main effect of maternal BMI or GWG on insulin requirements.ConclusionsThere is a significant increase in insulin requirements per kg during pregnancy in women with T1DM who were treated with an insulin pump.

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Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

Cited by 6 publications

References 126 publications

Pregnancy and diabetic retinopathy

Pregnancy and diabetic retinopathy

Evaluation of uric acid levels as antioxidant during normal pregnancy and pregnancy with complication (diabetes and hypertension)

Insulin requirements during pregnancy in women with type 1 diabetes treated with insulin pump

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