title: Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections of Insulin for the Management of Type 1 Diabetes Mellitus in Pregnancy: Association with Neonatal Chemical Hypoglycemia.
abstract: OBJECTIVE
  We hypothesized that patients with type 1 diabetes mellitus (T1DM) who were managed during their pregnancy with a continuous subcutaneous insulin infusion (CSII) would have a lower incidence of neonatal hypoglycemia (NH) than patients managed with multiple daily injections (MDI) of insulin.
  
  
  METHODS
  This was a retrospective cohort of 95 women with T1DM who delivered singleton, term neonates between 2007 and 2014. The primary outcome was incidence of NH (capillary plasma glucose ≤ 45 mg/dL) in the first 24 hours after birth.
  
  
  RESULTS
  The incidence of NH was 66.0% (62/95). The NH rate was significantly higher in women managed with CSII versus MDI (62 vs. 38%, p = 0.024). Neonates with NH had a higher birth weight (3,867 ± 658 vs. 3,414 ± 619 g, p = 0.002). When analyzing intrapartum glucose management, mothers of neonates with NH had significantly less time managed on an insulin infusion (median interquartile range 7 [3.5-30.5] vs. 17.5 [2.0-17.5] hours, p = 0.014). In multivariable analysis, only maternal body mass index (BMI) (p = 0.035) and time on an insulin infusion (p = 0.043) were significantly associated with NH.
  
  
  CONCLUSIONS
  In our population of patients with T1DM, CSII was more prevalent in the NH group; however, when controlling for other factors, intrapartum glucose management and early maternal BMI were the only variables associated with NH.
authors.affiliation: Department of Reproductive Medicine, UC San Diego, San Diego, California.
authors.forename: James A
authors.initials: JA
authors.lastname: Sargent
authors.affiliation: Department of Reproductive Medicine, UC San Diego, San Diego, California.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Roeder
authors.affiliation: Department of Gynecologic Oncology, University of Florida, Jacksonville, Florida.
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Ward
authors.affiliation: Department of Reproductive Medicine, UC San Diego, San Diego, California.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Moore
authors.affiliation: Department of Reproductive Medicine, UC San Diego, San Diego, California.
authors.forename: Gladys A
authors.initials: GA
authors.lastname: Ramos
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000151:congenital / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D007231:Infant, Newborn; D055104:Infusions, Subcutaneous; D007267:Injections; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human