Complications and Fetal Outcome in Diabetic Pregnancy

Abstract

From 1978 to 1986 a total of 189 pregnant diabetic women gave birth at our hospital. In this randomized prospective study the influence of maternal diabetes treatment in normoglycemic patients, continuous subcutaneous insulin infusion (n = 48) versus intensified conventional treatment (n = 41), is evaluated. These two groups of patients are further compared to patients (n = 28) who underwent conventional diabetes treatment during pregnancy. It can be shown from our data that the rate of complications such as preeclampsia, intrauterine growth retardation, premature labor and premature delivery can be reduced by intensified conventional and insulin pump treatment as compared to conventionally treated patients with late onset of pregnancy care. As expected, in the groups of CSIIand ICT patients no difference in the rate of pregnancy complications nor in fetal outcome could be demonstrated. Among CSII pregnancies 12/48 were complicated, in the ICT population the respective figure was 13/41 (CT: 20/28). The mean gestational age at the time of delivery ranged between 38 and 40 weeks, depending on the severity of maternal diabetes. CT patients were delivered earlier in all White classes. Fetal morbidity was nearly equal in CSII and ICT children, in CT patients it was greatly enhanced. Also the mortality (perinatal and neonatal) was considerably larger in CT patients (6/28), again, in the CSII and ICT population the mortality was nearly identical (2/48 and 3/41). We conclude, from our prospective information, that insulin pump therapy during pregnancy is indicated if intensified conventional treatment does no lead to normoglycemia. This may be the case if maternal diabetes is complicated by dysregulated insulin resorption, prolonged duration of diabetes, or inconsistant working or living conditions. It could be demonstrated that the higher primary costs of ICT as well as CSII therapy are very effective as compared to conventional treatment.

Continuous subcutaneous insulin infusion versus multiple daily injections in children and young people at diagnosis of type 1 diabetes: the SCIPI RCT

“…A meta-analysis of 20 studies comparing CSII with MDI detected an improvement of 0.61% in adults, suggesting that, in addition to this estimate being the minimum clinically important, it is also a realistic difference to detect. [81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100] To achieve 80% power, a sample size of 143 in each group was required to detect a difference in means of 0.50, assuming that the common SD is 1.50 using a two-group t-test with a 0.05 two-sided significance level. Allowing for 10% loss to follow-up increased the sample size to a total of participants (158 per group).…”

Continuous subcutaneous insulin infusion vs multiple daily injections in pregnant women with type 1 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials and observational studies

“…In the general T1DM population, it has been shown that when compared with MDI, CSII was associated with a slightly lower HbA 1c level and a smaller risk of severe hypoglycaemia (12). Until now, however, only a few small randomised control trials (RCTs) including T1DM pregnant women have been performed, and no firm understanding as to whether either of these treatment methods is advantageous in this particular patient population exists (13,14,15). Two comprehensive reviews comparing CSII with MDI in pregnancy complicated by T1DM were in fact recently published.…”

Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years

“…Intensified insulin therapy using continuous subcutaneous insulin infusion by external pumps (CSII) has become a therapeutic routine for Type 1 diabetes in a number of diabetes centres since its introduction in 1978 [1]. Its efficacy and safety have been evaluated in several uncontrolled [2][3][4][5][6][7][8][9][10][11][12][13][14] and controlled [15][16][17][18][19][20][21][22][23] trials. The results of these studies have been quite heterogeneous: whereas improvements of metabolic control and the possibility of more flexibility of daily life schedules were reported by some authors, there were also reports of increased complications, e.g.…”