Pregnancy in Patients with Type One Diabetes Mellitus Treated with Continuous Subcutaneous Insulin Infusion—Preconception Basal Insulin Dose as a Potential Risk Factor for Fetal Overgrowth?

Gloria Lekšić, Maja Baretić, Marina Ivanišević and Dubravka Jurišić-Eržen
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Gloria Lekšić: Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
Maja Baretić: Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
Marina Ivanišević: School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
Dubravka Jurišić-Eržen: Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia

IJERPH, 2020, vol. 17, issue 18, 1-7

Abstract: Despite widespread use of technology, type one diabetes mellitus (T1DM) is still a great clinical challenge during pregnancy. This study aims to assess how prenatal variables of T1DM patients using continuous subcutaneous insulin infusion (CSII) influence pregnancy outcomes. We performed a retrospective study of 35 patients with T1DM treated with CSII during pregnancy. Alterable preconception variables (A1C, body mass index, basal and bolus insulin dose) were analysed as possible contributors to birth weight and large-for-gestational-age (LGA) prevalence. Inclusion criteria were presence of T1DM for more than two years, A1C < 7.4% and treatment with CSII for at least three months prior to conception. The preconception basal insulin dose and A1C had a significant correlation to the neonatal birth weight ( p = 0.01, r = 0.4 and p = 0.04, r = 0.3, respectively) and were significant in regression analysis together contributing 22% of the variance in birth weight percentiles (sig = 0.17, R square = 0.22). Prevalence of LGA was 46%. Women who had LGA neonates also had a higher preconception basal insulin dose compared to women with non-LGA neonates (26 ± 9 vs. 18 ± 7 IU (international units), p = 0.01). The LGA group had a higher preconception A1C, but it did not reach statistical significance (6.5 ± 0.5% vs. 6.2 ± 0.9%, respectively, p = 0.2). Women with T1DM treated with CSII who had unregulated glycaemia and more basal insulin were at greater risk for development of LGA neonates.

Keywords: type one diabetes mellitus; pregnancy; preconception; insulin pump; large-for-gestational-age neonates (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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