Pre-pregnancy care and pregnancy outcomes in type 1 diabetes mellitus: a comparison of continuous subcutaneous insulin infusion and multiple daily injection therapy

Karl Neff, Rita Forde, Claire Gavin, Maria Byrne, Richard Firth, Sean Daly, Fionnuala McAuliffe, Michael Foley, Mary Coffey, Brendan Kinsley

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

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. Aim 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.
Original languageEnglish
Article number10.1007/s11845-013-1027-6
Pages (from-to)397-403
Number of pages7
JournalIrish Journal of Medical Science
DOIs
Publication statusPublished - 2014

Keywords

  • diabetes mellitus
  • Pregnancy
  • Pre-pregnancy planning
  • Continuous subcutaneous insulin infusion

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