Insulin Analogues in the Management of the Pregnancy Complicated by Diabetes Mellitus

Durnwald, Celeste; Landon, Mark B.

doi:10.1007/s11892-010-0160-0

Cited by 16 publications

(11 citation statements)

References 47 publications

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“…Another change in recent years has been the use of rapid-acting insulin analogues instead of human insulin. It is unlikely, however, that this could have resulted in the trend for increased HbA 1c since rapid-acting insulin analogues are equally effective [36].…”

Section: Discussionmentioning

confidence: 99%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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Aims/hypothesis Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome. Methods We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother. Results Maternal BMI increased significantly during 1989-2008 (p<0.001). The mean HbA 1c in the first trimester remained unchanged, but the midpregnancy and the last HbA 1c before delivery increased (p00.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA 1c value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia. Conclusions/interpretation Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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“…Recent literature reviews [5][6][7] surveyed clinical studies for comparisons of fetal overgrowth between RI and insulin analogs, including LP, in pregnancies complicated by diabetes. These qualitative reviews concluded that overall there were no relevant differences in rates of neonatal macrosomia and LGA between LP and RI treatment groups.…”

mentioning

confidence: 99%

“…10,11 Although based on unadjusted analyses, observational studies in pregnant patients also found benefits of LP over RI, with better glycemic control 4,7,12 and less hypoglycemia. 4,7 A fuller assessment of the risks and benefits of LP remains to be studied in pregnant insulintreated patients with diabetes.…”

mentioning

confidence: 99%

Studies Assessing Risk of Treatments for Diabetes Mellitus and Adverse Pregnancy Outcomes Should Control for Known Risk Factors

Edson-Heredia¹,

Rohwer²,

Wong³

et al. 2012

Diabetes Technology & Therapeutics

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T he meta-analysis by González Blanco et al. 1 examining pregnancy outcomes and use of insulin lispro (LP) or regular insulin (RI) in women with type 1 diabetes mellitus (T1DM) found that use of LP compared with RI was associated with higher risk of large-for-gestational age (LGA) infants (risk ratio 1.38 [95% confidence interval 1.14, 1.68]). The study's analysis of relative risk of LGA, determined from three observational studies, 2-4 did not adjust for known risk factors impacting infant birth weight. The authors' conclusions of a higher rate of LGA newborns in pregnant women treated with LP and ''no evidence of a beneficial effect of LP use during pregnancy'' should therefore be interpreted with caution.Recent literature reviews 5-7 surveyed clinical studies for comparisons of fetal overgrowth between RI and insulin analogs, including LP, in pregnancies complicated by diabetes. These qualitative reviews concluded that overall there were no relevant differences in rates of neonatal macrosomia and LGA between LP and RI treatment groups. Because of the small numbers of events in each of the studies included in our review, 6 we concluded that there were no relevant differences and presume that the other two reviews may have had the same reasoning, perhaps because each study had small numbers of such events.The known risk factors that impact infant birth weight are maternal age, body mass index, diabetes duration, parity, infant gender, and smoking status. 8 The meta-analysis by González Blanco et al. 1 noted that baseline characteristics in patients treated with LP were similar to those treated with RI; however, only two factors-age and duration of diabeteswere evaluated in all three studies' data. Availability of baseline data on known risk factors impacting infant birth weight would allow for a more appropriate meta-analysis that properly accounts for these covariates. Ideally, data analysis on the individual patient level would be most informative. It may be useful to provide a brief summary here of the individual observational studies used in the analysis by González Blanco et al. 1 of LGA and LP, all of which are based on a pregnant female patient population with T1DM:One publication that was not included in the aforementioned literature reviews, an unintentional omission in our review and probably also for the others, was that of Evers et al., 2 based on a prospective observational study in The Netherlands that included 289 patients, 11% of whom were treated with LP. The study found a high percentage of macrosomia (48.8%), defined as birth weight > 90 th percentile, despite good glycemic control in the total cohort. The authors concluded an association of LP and LGA on the basis of an odds ratio that was not statistically significant (odds ratio 3.1, 95% confidence interval 0.9-10.4). Evers et al. 2 stated that maternal age, race, and parity were not associated with macrosomia. Additionally, they reported that duration of diabetes, long-term diabetes complications, total daily insulin dosage, body mass inde...

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“…Edson-Heredia et al 1 point out that recent literature reviews [5][6][7] concluded that there were no relevant differences in rate of macrosomia and LGA, but we would like to underscore that all of them are qualitative reviews. The difference is that we performed a systematic review and meta-analysis.…”

mentioning

confidence: 89%

Response to “Studies Assessing Risk of Treatments for Diabetes Mellitus and Adverse Pregnancy Outcomes Should Control for Known Risk Factors”

González¹,

Corcoy²

2012

Diabetes Technology & Therapeutics

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Insulin Analogues in the Management of the Pregnancy Complicated by Diabetes Mellitus

Cited by 16 publications

References 47 publications

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Studies Assessing Risk of Treatments for Diabetes Mellitus and Adverse Pregnancy Outcomes Should Control for Known Risk Factors

Response to “Studies Assessing Risk of Treatments for Diabetes Mellitus and Adverse Pregnancy Outcomes Should Control for Known Risk Factors”

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