Inadequate pregnancy planning in diabetics, and its impact on glycemic control and complications

Imai, Roberta Yukari; Monteagudo, Patrícia Teófilo; Mattar, Rosiane; Dib, Sérgio Atala; Dualib, Patricia; Almeida-Pititto, Bianca de

doi:10.1007/s00404-022-06806-8

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“…Unfortunately, we do not have information on whether the pregnancies were planned or not, but recently, our group published a study that evaluated the intention of pregnancy and its influence on the HbA1c profile before and during pregnancy in women with previously diagnosed DM, which included some participants from the current study. The results showed that glycemic control did not differ between the groups that did or did not intend to become pregnant, with a mean prepregnancy HbA1c value of 9.3%, even with 83.3% reporting having received guidance on the importance of glucose control and contraception before becoming pregnant (33).…”

Section: Discussionmentioning

confidence: 89%

Maternal-fetal outcomes of pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion or multiple daily injections during pregnancy – A Brazilian health care referral center cohort study

Ogassavara¹,

Dualib²,

Mattar³

et al. 2023

Archives of Endocrinology and Metabolism

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Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion:In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.

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Section: Discussionmentioning

confidence: 89%