title: Experiences of continuous subcutaneous insulin infusion in pregnant women with type 1 diabetes during delivery from four Italian centers: a retrospective observational study.
abstract: OBJECTIVE
  An optimized metabolic control during delivery is mandatory to prevent maternal-neonatal complications. The primary aim of this study was to evaluate the efficacy and safety of continuous subcutaneous insulin infusion (CSII) during delivery in pregnant women with type 1 diabetes. The secondary aim was to assess the impact of real-time continuous glucose monitoring (RT-CGM) added to CSII versus CSII alone.
  
  
  METHODS
  This was a multicenter observational retrospective study. A standardized protocol, to use CSII throughout pregnancy and delivery, foresaw three different insulin basal rates according to blood glucose level: profile A, the last basal rate in use; profile B, preventive 50% reduction of the last basal rate in use; and profile C, 0.1-0.2 U/h for blood glucose level <70 mg/dL, activated just before anesthesia or at the beginning of active labor. An alternative intravenous protocol (IVP) was given in case of complications and relevant metabolic deterioration. Blood glucose in the target range (70-140 mg/dL) throughout delivery and percentage of activation of the IVP were primary outcomes.
  
  
  RESULTS
  Sixty-five pregnant women with diabetes included in the study (56-86% cesarean section; 9-14% spontaneous/stimulated vaginal delivery). Mean blood glucose level was 102 ± 31 mg/dL at 0 min, 109 ± 42 mg/dL at 30 min, 120 ± 48 mg/dL at 60 min, and 99 ± 34 mg/dL at 24 h. Mean basal rate during delivery was 0.6 ± 0.4 U/h (profile B). Mean capillary blood glucose (CBG) level was lower in the RT-CGM group relative to the CSII-alone group: 80 ± 14 mg/dL versus 111 ± 32 mg/dL at 0 min (P<0.01), 79 ± 11 mg/dL versus 109 ± 42 mg/dL at 30 min (P<0.02), and 98 ± 20 mg/dL versus 125 ± 51 mg/dL at 60 min (difference not significant). Eleven newborns experienced transient neonatal hypoglycemia. None of the women switched to IVP. No major differences were observed according to delivery procedure.
  
  
  CONCLUSIONS
  CSII is possible and safe in different types of delivery in selected and educated women. RT-CGM helps to obtain better outcomes in terms of maternal peripartum CBG level.
authors.affiliation: Department of Endocrinology & Diabetology, District n°63, Azienda Sanitaria Locale, Salerno, Italy. lellafresa@hotmail.com
authors.forename: Raffaella
authors.initials: R
authors.lastname: Fresa
authors.forename: Natalia
authors.initials: N
authors.lastname: Visalli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Blasi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cavallaro
authors.forename: Egle
authors.initials: E
authors.lastname: Ansaldi
authors.forename: Oria
authors.initials: O
authors.lastname: Trifoglio
authors.forename: Santina
authors.initials: S
authors.lastname: Abbruzzese
authors.forename: Marzia
authors.initials: M
authors.lastname: Bongiovanni
authors.forename: Mariano
authors.initials: M
authors.lastname: Agrusta
authors.forename: Angela
authors.initials: A
authors.lastname: Napoli
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007231:Infant, Newborn; D055104:Infusions, Subcutaneous / Q000379:methods*; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood; D007332:Insulin Infusion Systems; D007558:Italy / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin