Continuous Subcutaneous Insulin Infusion During Pregnancy in Women with Complicated Type 1 Diabetes Is Associated with Better Glycemic Control but Not with Improvement in Pregnancy Outcomes.
BACKGROUND
The aim of this study was to evaluate maternal and fetal pregnancy outcomes of women with type 1 diabetes managed on continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI).


METHODS
Pregnancy outcomes were assessed retrospectively in women with type 1 diabetes who were patients of the Diabetes Clinic of North Karelia Hospital (Joensuu, Finland) between 2000 and 2012. The medical records of 72 women experiencing 135 pregnancies and data of their infants were retrospectively reviewed.


RESULTS
In total, 48 pregnancies were treated with CSII and 87 with MDI. Women on CSII treatment were older and had more diabetes complications compared with women on MDI. No significant differences in glycated hemoglobin (HbA1c) levels were observed between the CSII and MDI groups before or during pregnancy. Maternal or fetal outcomes did not differ between the treatment groups. However, among women with complicated diabetes, HbA1c levels were significantly lower in the CSII group until the second trimester (prepregnancy, 7.22% vs. 8.14%, respectively [P = 0.034]; first trimester, 6.85% vs. 7.87% [P < 0.001]; second trimester, 6.41% vs. 7.03% [P = 0.029]) without an increased rate of maternal hypoglycemia.


CONCLUSIONS
Pregnancy outcomes were similar regardless of insulin treatment modality. Although using an insulin pump did not result in improvement of pregnancy outcomes, it allowed for better glycemic control in pregnancies of women with complicated diabetes. Therefore, it is worth considering in high-risk T1DM pregnancies, especially if good glycemic control is not achieved otherwise.
1 Department of Internal Medicine, Hospital District of North Karelia , Joensuu, Finland .
Päivi
P
Kekäläinen
2 Department of Pediatrics, Hospital District of North Karelia , Joensuu, Finland .
Mari
M
Juuti
3 Department of Obstetrics and Gynecology, Hospital District of North Karelia , Joensuu, Finland .
Tiina
T
Walle
4 Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio, Finland .|5 Hospital District of North Karelia , Joensuu, Finland .|6 Department of Chronic Disease Prevention, National Institute for Health and Welfare , Helsinki, Finland.
Tiina
T
Laatikainen
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D010044:Outpatient Clinics, Hospital; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy*; D018566:Pregnancy, High-Risk; D015995:Prevalence; D012189:Retrospective Studies
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human