title: Pre-pregnancy care and pregnancy outcomes in type 1 diabetes mellitus: a comparison of continuous subcutaneous insulin infusion and multiple daily injection therapy.
abstract: BACKGROUND
  Pre-pregnancy care improves pregnancy outcomes in type 1 diabetes mellitus (T1DM). Continuous subcutaneous insulin infusion (CSII) therapy and multiple daily injection (MDI) therapy can both be used to achieve glycaemic targets, but few data are available to compare their efficacy in pre-pregnancy care.
  
  
  OBJECTIVE
  To compare MDI and CSII in pre-pregnancy care in T1DM.
  
  
  METHODS
  Retrospective database review of women with T1DM attending the Dublin Diabetes in Pregnancy Centre.
  
  
  RESULTS
  464 women with T1DM (40 treated with CSII) were included. Women attending for pre-pregnancy care had lower HbA1c levels at booking to antenatal services [52 ± 10 mmol/mol (6.9 ± 0.9 %) vs. 62 ± 16 mmol/mol (7.8 ± 1.5 %), p < 0.001], and booked at an earlier gestation (6 ± 2 vs. 8 ± 6 weeks, p < 0.001). In those who attended for pre-pregnancy care, the CSII group had lower HbA1c levels at booking than those using MDI [48 ± 8 mmol/mol (6.5 ± 0.7 %) vs. 53 ± 10 mmol/mol (7.0 ± 0.9 %), p = 0.03]. Gestational age at delivery and birth weight did not differ between groups. Caesarean section rates were associated with CSII use (p < 0.001), duration of diabetes (p = 0.002), and parity (p = 0.006). Nulliparous women using CSII with a longer history of diabetes were more likely to deliver by Caesarean section. There was no perinatal mortality.
  
  
  CONCLUSIONS
  Pre-pregnancy care delivered by a specialist multi-disciplinary team effectively reduces HbA1c levels peri-conception. CSII use results in lower HbA1c levels in pre-pregnancy care in selected individuals and should be considered in women with T1DM planning pregnancy.
authors.affiliation: Dublin Diabetes in Pregnancy Centre, Mater Misericordiae University Hospital, 30 Eccles St, Dublin 7, Republic of Ireland.
authors.forename: K J
authors.initials: KJ
authors.lastname: Neff
authors.forename: R
authors.initials: R
authors.lastname: Forde
authors.forename: C
authors.initials: C
authors.lastname: Gavin
authors.forename: M M
authors.initials: MM
authors.lastname: Byrne
authors.forename: R G R
authors.initials: RG
authors.lastname: Firth
authors.forename: S
authors.initials: S
authors.lastname: Daly
authors.forename: F M
authors.initials: FM
authors.lastname: McAuliffe
authors.forename: M
authors.initials: M
authors.lastname: Foley
authors.forename: M
authors.initials: M
authors.lastname: Coffey
authors.forename: S
authors.initials: S
authors.lastname: Coulter-Smith
authors.forename: B T
authors.initials: BT
authors.lastname: Kinsley
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable; D055104:Infusions, Subcutaneous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D016742:Preconception Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000628:therapy*; D011295:Prenatal Care; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin