By Jill Stein
ROME -- September 9, 2008 -- Pregnant women with type 1 diabetes and their babies benefit more from use of continuous subcutaneous insulin infusions (CSII) during pregnancy than from multiple daily injections (MDI) of insulin, according to 6-month data presented here at the European Association for the Study of Diabetes (EASD) 2008.
Peter J. Hammond, Harrogate and District Foundation Trust, Harrogate, United Kingdom, and associates compared the use of CSII and MDI for delivering target outcomes in pregnant women with type 1 diabetes and their babies.
"There is conflicting evidence as to the potential benefit of CSII over MDI in pregnant women with type 1 diabetes," Dr. Hammond said in a presentation on September 9. "Since 1999, we have offered CSII to all women with type 1 diabetes presenting either already pregnant or planning a pregnancy."
The study included a total of 73 pregnancies between 1999 and 2007.
Of the 39 women who used CSII during their pregnancy, 30 were using it preconception and 9 switched from MDI late in the first trimester or early in the second trimester. There were 34 live births, 11 of which were premature. There were 3 miscarriages and 2 still births.
In the 34 pregnancies among women who used MDI alone, there were 30 live births, 6 of which were premature. There were 3 miscarriages and 2 terminations for anencephaly.
Levels of haemoglobin (Hb) A1C were significantly lower in women using CSII prior to conception (7.3% vs 8.2%) and in the first trimester (6.9% vs 7.7%). The 2 groups did not differ in terms of Hb A1C levels in the second and third trimesters.
Women who converted to CSII during pregnancy had the best mean Hb A1C levels for the duration of their pregnancy. CSII users had significantly less severe hypoglycaemic episodes than MDI users.
All but 1 of the women using CSII remained on CSII during delivery and the women using CSII intrapartum had lower blood glucose levels within 1 hour of delivery than the women who used MDI and were managed with an IV glucose infusion (5.6 vs 7.0 mmol/L).
The 2 groups did not differ in terms of foetal abdominal circumference at 32 weeks' gestation, birth weight of babies delivered at term, incidence of neonatal respiratory distress, neonatal jaundice, or need for special care baby unit admission.
Maternal weight gain was significantly lower in the CSII cohort (12.0 kg vs 15.0 kg, P < .05). CSII users also required significantly less insulin.
Overall, the results show that pregnant women with type 1 diabetes may benefit from using CSII rather than MDI, with improved Hb A1C levels, particularly prepregnancy and during early pregnancy, and with less severe hypoglycaemia, Dr. Hammond said.
Also, CSII use was associated with improved maternal glucose control at delivery, with a reduced severity of neonatal hypoglycaemia, and less maternal weight gain and insulin demand throughout pregnancy.
Funding for this study was provided by Medtronic UK.
[Presentation title: An Audit of Pregnancy Outcomes in Type 1 Diabetes Comparing Continuous Subcutaneous Insulin Infusion With Multiple Daily Injections. Abstract 1125]
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