Abstract
Objective
The aim of the study was to compare pregnancy outcomes with glycemic control, total
increase in insulin requirement, and body weight gain in the women with Type 1 Diabetes
Mellitus (T1DM) using continuous subcutaneous insulin infusion (CSII) or multiple
daily injections (MDI).
Material and methods
This was a single center retrospective observational study involving 209 pregnant
Caucasian women. Among the study participants, 95 subjects were treated with MDI and
114 patients were using CSII therapy. The primary outcomes were pregnancy results,
while secondary ones were HbA1c, increase in daily dose of insulin (DDI), and body
weight gain.
Results
At baseline, the CSII users were older (P = 0.0373), they were diagnosed with T1DM
at a younger age (P = 0.047), and more often planned pregnancy (P = 0.032). A majority
of the women were classified as class D, according to the White classification. Among
the CSII users, a significantly higher proportion of the subjects in class B was noted
than in the MDI users, with no differences in the proportion of the remaining White
classes. Prepregnancy HbA1c was insignificantly lower in the CSII group, however,
a significantly higher proportion of the CSII users reached the target value of HbA1c
(P = 0.008). A prepregnancy daily dose of insulin (both total and per kg of body weight),
body weight, and body mass index (BMI) did not differ between the groups.
The 1st and 2nd trimester HbA1c was lower among the CSII users (6.83 ± 1.38 vs 7.52 ± 2.11%,
P = 0.01 and 6.17 ± 0.9 vs 6.57 ± 1.12%, P = 0.009, respectively), while the 3rd trimester
HbA1c as well as the total change in HbA1c were comparable. Neither DDI and body weight
in concecutive trimesters, nor their total gestational increase, differed between
the groups.
The rate of pregnancy loss, such as abortions, fetal and neonatal death did not differ
between the groups. As regards composite pregnancy loss, prepregnancy HbA1c was 8.41%±2.81%
among the MDI cohort vs 7.22%±1.31% in the CSII users (P = 0.517). No differences
were found in the gestational age at delivery, the mode of delivery, neonatal birth
weight, the rate of macrosomy, LGA or SGA. A higher Apgar score was noted among the
CSII users (8.63 ± 1.63 vs 8.03 ± 2.49%, P = 0.047), however, the proportion of neonates
with an Apgar score lower than 7 points was similar. In the women planning pregnancy,
as compared to the subjects who did not, HbA1c was significantly lower in the 1st
trimester, together with a significantly higher rate of the women achieving the target
HbA1c value during planning as well as in the 1st trimester. In the group of women
planning pregnancy, significantly lower 1st trimester HbA1c and composite outcome
of pregnancy loss were observed in the CSII users vs the MDI treated women. Lack of
pregnancy planning and a high HbA1c level in the 1st trimester were independent predictors
of both LGA (OR = 4.99 [95%CI 1.12–21.0], P = 0.033 and OR = 3.02 [95%CI 1.19–7.65],
P = 0.019, respectively) and macrosomia (OR = 8.43 [95%CI 1.36–51.93], P = 0.021 and
OR = 5.47 [95%CI 1.77–16.87], P = 0.003, respectively).
Conclusions
The course of pregnancy and obstetric outcomes were not dependent on the mode of insulin
delivery, but only on pregnancy planning and HbA1c in early pregnancy. Further studies
are needed to explore more precise parameters describing both glycemic control in
pregnant women as well as perinatal infant well-being.
Keywords
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Article info
Publication history
Published online: December 21, 2020
Accepted:
December 10,
2020
Received in revised form:
December 4,
2020
Received:
July 24,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
