Glycemic Control and Perinatal Outcomes of Pregnancies Complicated by Type 1 Diabetes: Influence of Continuous Subcutaneous Insulin Infusion and Lispro Insulin

Abstract

Pregnant women with T1DM using LP and/or CSII had different characteristics. LP with or without CSII was independently associated with fewer hypoglycemic comas, whereas impact of LP/CSII on the fetus had a favorable or an unfavorable influence depending on the specific outcome.

Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

“…and fetal outcomes. [51][52][53][54][55][56] The mean age of study participants was 26 to 31 years, with most participants in the CSII group enrolled into the studies prior to becoming pregnant. Most participants had diabetes duration of 7.7 to 13.9 years, with participants in the CSII groups having the longest duration of diabetes.…”

“…[51][52][53][54][55][56] The strength of evidence of the data that compared CSII with MDI among pregnant women with pre-existing T1DM was insufficient for all other maternal and neonatal outcomes due to lack of RCTs and, therefore, a high risk of bias. There was no statistical difference in maternal weight gain, 52,54,56 gestational age at delivery, 51,[53][54][55] birth weight, [53][54][55] and minor congenital anomalies 51,54 between the CSII and MDI intervention groups.…”

“…[51][52][53][54][55][56] The strength of evidence of the data that compared CSII with MDI among pregnant women with pre-existing T1DM was insufficient for all other maternal and neonatal outcomes due to lack of RCTs and, therefore, a high risk of bias. There was no statistical difference in maternal weight gain, 52,54,56 gestational age at delivery, 51,[53][54][55] birth weight, [53][54][55] and minor congenital anomalies 51,54 between the CSII and MDI intervention groups. Also, meta-analyses of retrospective studies showed nonsignificant relative risks for rates of C-section (RR = 1.01; 95% CI, 0.86-1.20), [53][54][55][56] severe hypoglycemia (RR = 0.78; 95% CI, 0.23-2.65), [54][55][56] admission to the neonatal intensive care unit (RR = 0.84; 95% CI, 0.43-1.68), 54,55 pre-term delivery (RR = 0.98; 95% CI, 0.67-1.43), [53][54][55][56] and frequency of neonatal hypoglycemia (RR = 1.01; 95% CI, 0.86-1.20).…”

“…Also, meta-analyses of retrospective studies showed nonsignificant relative risks for rates of C-section (RR = 1.01; 95% CI, 0.86-1.20), [53][54][55][56] severe hypoglycemia (RR = 0.78; 95% CI, 0.23-2.65), [54][55][56] admission to the neonatal intensive care unit (RR = 0.84; 95% CI, 0.43-1.68), 54,55 pre-term delivery (RR = 0.98; 95% CI, 0.67-1.43), [53][54][55][56] and frequency of neonatal hypoglycemia (RR = 1.01; 95% CI, 0.86-1.20). [53][54][55][56] Additionally, metaanalyses for major congenital anomalies showed a pooled RR of 2.12 that favored MDI but was not statistically significant. 55,56 Due to the lack of RCTs, which leads to a high risk of bias of all the above outcomes, the EPC investigators suggested that results were inconclusive.…”

Consecutive measurements show association of IGF-1 with preterm delivery in type 1 diabetic pregnancy

“…Several studies provide evidence that high AER may trigger adverse pregnancy outcome, but the cause may not be diabetes in itself and our findings with a mixed diabetes population add to this argument [11]. As for insulin doses and glycemia, preterm delivery was improved insignificantly in two smaller studies on continuous subcutaneous insulin infusion comparing with the multiple injection regimens, which we started in the women [9,[18][19][20][21]. However, the treatment of previous unrecorded glycemic fluctuations may help improve the obstetric outcome on many aspects including preterm deliveries and more appropriate growth patterns of the neonates.…”