title: Macrosomia in well controlled CSII treated Type I diabetic pregnancy.
abstract: OBJECTIVE
  To survey the effect of tight glycemic control by insulin pumps, of pre-gestational Type 1 diabetic women on pregnancy outcome.
  
  
  METHODS
  Twelve consecutive Type 1, insulin pump treated, diabetic patients followed in the high risk maternal - fetal clinic were ascertained. Data regarding glucose control was assessed and correlated with pregnancy outcome.
  
  
  RESULTS
  A total of 14 deliveries (10 singleton) were assessed. There were no miscarriages, one baby that was born with a ventricular septal defect (VSD). Glycemic control was within the acceptable guidelines. HbA1c (%) by trimesters: 6.5 +/- 0.9, 5.9 +/- 0.7, 5.8 +/- 0.6 and average glucose (mg/dL) 121.0 +/- 15.2, 114.8 +/- 13.2, 116.0 +/- 21.1. Average birth weight was 3312.1 +/- 750.2 g with five babies (35%) weighting over 4.0 kg at birth. Birth weight was significantly correlated with HbA1c at the first trimester, mean glucose at trimester 1 and 2, and maternal weight at delivery (r = 0.74, p = 0.045; r = 0.72, p = 0.051; r = 0.74, p = 0.046; r = 0.74, p = 0.04, respectively).
  
  
  CONCLUSIONS
  Our study of a limited number of patients suggest that women with pre-gestational diabetes obtaining acceptable glycemic goals with insulin pump therapy have increased risk of macrosomia. Current glycemic goals and therapies in treating pre-gestational diabetic patients therefore might not be sufficient to normalise pregnancy outcomes in of women with pre-gestational diabetes.
authors.affiliation: Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel. ohdcohen@sheba.health.gov.il
authors.forename: Ohad
authors.initials: O
authors.lastname: Cohen
authors.forename: Naomi
authors.initials: N
authors.lastname: Keidar
authors.forename: Michal
authors.initials: M
authors.lastname: Simchen
authors.forename: Boaz
authors.initials: B
authors.lastname: Weisz
authors.forename: Mordechai
authors.initials: M
authors.lastname: Dolitsky
authors.forename: Eyal
authors.initials: E
authors.lastname: Sivan
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005320:Fetal Macrosomia / Q000517:prevention & control*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin