Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out‐patient education adapted for pregnancy

Howorka, Kinga; Pumprla, J.; Gabriel, Mario; Feiks, A.; Schlusche, C.; Nowotny, Ch.; Schober, Edith; Waldhoer, Thomas; Langer, Martin

doi:10.1046/j.1464-5491.2001.00621.x

Cited by 43 publications

(19 citation statements)

References 35 publications

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“…The fact that in our study metabolic control in the first trimester was significantly better in T2DM than in T1DM patients is consistent with many previous reports [23][24][25][26][27][28][29][30][31]. The improvement in glycemic control in subsequent trimesters is an obvious result of the treatment intensification during the pregnancy [32]. Interestingly, mean HbA1c in T2DM and T1DM subjects in the second and third trimesters was within the goal of glycemic control as set by international and local guidelines [19,[33][34][35][36].…”

Section: Discussionsupporting

confidence: 94%

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects

et al. 2011

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The number of pregnancies complicated by type 2 diabetes mellitus (T2DM) is growing; however, their clinical characteristics remain incomplete. We aimed to assess clinical characteristics, glycemic control, and selected pregnancy outcomes in pregestational T2DM from Poland and to compare them with those of T1DM. We analyzed 415 consecutive singleton pregnancies; among them, there were 70 women with T2DM and 345 with T1DM. As compared to T1DM patients, women with T2DM were older (mean age 33.1 years vs. 27.8, respectively), heavier before pregnancy (mean BMI 30.8 kg/m² vs. 23.9), and had a shorter duration of diabetes (mean 3.3 years vs. 11.4); ( P<0.0001 for all comparisons). The gestational age at the first visit was higher in T2DM (mean 11.4 weeks vs. 8.6; P=0.0004). Nevertheless, they had better glycemic control in the first trimester (mean HbA1c 6.2% vs. 7.0; P=0.003); in subsequent months, the differences in HbA1c were no longer significant. T2DM women gained less weight during pregnancy (mean 9.9 kgs vs. 14.1; P<0.0001). The proportion of miscarriages (10.0 vs. 7.3%; P=0.32), preterm deliveries (12.7 vs. 17.8%; P=0.32), combined infant deaths, and congenital malformations were similar in both groups (9.5 vs. 8.8%; P=0.4) as was the frequency of caesarean sections (58.7 vs. 64.1%; P=0.30). Macrosomic babies were more than twice less frequent in T2DM and the difference reached borderline significance (7.9 vs. 17.5%, P=0.07). Pregnancy planning in T2DM had a significant impact on HbA1c in the first trimester (5.7 vs. 6.4% in the planning vs. the not planning group, P=0.02); the difference was not significant in the second and third trimester. T2DM women had better glycemic control in the first trimester than T1DM subjects and gained less weight during pregnancy. This could have been the reason for the slightly lower number of macrosomic babies but did not affect other outcomes. In T2DM, pregnancy planning had a beneficial glycemic effect in the first trimester.

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Section: Discussionsupporting

confidence: 94%

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects

et al. 2011

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“…SUs have been shown to be more effective than insulin for glycemic diabetes control in PNDM related to Kir6.2 in patients of various ages (4,7,9,10). The normalization of glucose levels is a priority to improve the maternal and neonatal outcomes of pregnancies complicated by diabetes (17). Hyperglycemia during organogenesis is associated with increased risk of congenital malformations affecting the neural tube, heart, and skeleton (18).…”

Section: Discussionmentioning

confidence: 99%

The First Case Report of Sulfonylurea Use in a Woman with Permanent Neonatal Diabetes Mellitus due toKCNJ11Mutation during a High-Risk Pregnancy

Klupa

Kozek

Nowak

et al. 2010

The Journal of Clinical Endocrinology &Amp; Metabolism

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Sulfonylureas (SUs) were proven to be more effective than insulin in most Kir6.2 permanent neonatal diabetes mellitus (PNDM) patients. We report SU use during pregnancy in PNDM. A woman with the R201H Kir6.2 mutation became pregnant at the age of 37. The patient had been on glipizide 30 mg for 3 yr; her glycosylated hemoglobin level was 5.8%. She was diagnosed with chronic diabetes complications and a congenital defect of the urogenitary tract-a bicornuate uterus with septum. Because the effect of SU on fetal development is uncertain, she was switched to insulin after the pregnancy diagnosis; however, the subsequent glycemic control was unsatisfactory, with episodes of hyper- and hypoglycemia. Thus, in the second trimester, the patient was transferred to SU (glibenclamide, 40 mg), which resulted in stabilization of glycemic control; glycosylated hemoglobin in the third trimester was 5.8%. Prenatal genetic testing excluded the Kir6.2 R201H mutation in the fetus. A preterm cesarean delivery was carried out in the 35th week. The Apgar score of the newborn boy (weight, 3010 g; 75th percentile) was 8 at 1 min. He presented with hypoglycemia, transient tachypnea of the newborn, and hyperbilirubinemia. The recovery was uneventful. No birth defects were recorded. His development at the ninth month of life was normal. In summary, we show a high-risk pregnancy in long-term PNDM that despite perinatal complications ended with the birth of a healthy child. SUs, which seem to constitute an alternative to insulin during pregnancy in Kir6.2-related PNDM, were used during the conception period and most of the second and third trimesters.

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“…Neonatal hypoglycemia occurred mainly within 3 h of birth and all in preterm deliveries, a well-known risk factor for this neonatal complication 32 ; moreover, the frequency of neonatal hypoglycemia recorded in the present study (17%) was comparable to that reported in other European studies. 20,33,34 We also recorded a low percentage of cumulative respiratory disorders in neonates. This last finding allowed the return to the ward and breastfeeding in the majority of newborns as demonstrated by the low percentage of neonatal intensive care unit admissions.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Continuous Subcutaneous Insulin Infusion in Pregnant Women with Type 1 Diabetes During Delivery from Four Italian Centers: A Retrospective Observational Study

Fresa

Visalli

Blasi

et al. 2013

Diabetes Technology & Therapeutics

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Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out‐patient education adapted for pregnancy

Abstract: Structured, comprehensive, modular out-patient group education promoting self-choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.

Cited by 43 publications

References 35 publications

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects

The First Case Report of Sulfonylurea Use in a Woman with Permanent Neonatal Diabetes Mellitus due toKCNJ11Mutation during a High-Risk Pregnancy

Experiences of Continuous Subcutaneous Insulin Infusion in Pregnant Women with Type 1 Diabetes During Delivery from Four Italian Centers: A Retrospective Observational Study

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