Tags

Type your tag names separated by a space and hit enter

Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection.
Diabet Med. 2019 02; 36(2):158-166.DM

Abstract

AIMS

To compare glycaemic control, maternal and neonatal outcomes in pregnancies with Type 1 diabetes, managed either by continuous subcutaneous insulin infusion, multiple daily insulin injection or switch from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) in early pregnancy.

RESEARCH DESIGN AND METHODS

Data from 339 singleton pregnancies were retrospectively reviewed. HbA1c values were measured preconception and in each trimester. In a secondary analysis, use of CSII pre-pregnancy was compared with initiation of CSII during pregnancy.

RESULTS

MDI was used in 140 pregnancies (41.3%) and CSII was used in 199 (58.7%), including 34 pregnancies (10.0%) during which the women switched to CSII. In pregnancies during which CSII was used duration of diabetes [median (interquartile range) 16.0 (8.0-23.0) years vs 11.0 (5.5-17.5) years; P<0.001] was longer, and the Institute of Medicine recommendations for appropriate weight gain were exceeded more often (64.8% vs. 50.8%; P=0.01). CSII use and pre-pregnancy BMI were independent predictors of excess weight gain. There was no difference in glucose control, but CSII was associated with higher birth weight [median (interquartile range) 3720 (3365-4100) g vs 3360 (3365-4100) g; P<0.001] and higher large-for-gestational-age (LGA) rate (44.7% vs. 33.6%; P=0.04) than MDI. HbA1c concentration in the third trimester and excess weight gain were predictive of LGA infants [odds ratio 2.33 (95% CI 1.54-3.51); P<0.001 and 1.89 (95% CI 1.02-3.51); P=0.04]. In pregnancies where CSII therapy was initiated in the first trimester and in those with pre-pregnancy use, similar glucose control and outcome was achieved.

CONCLUSIONS

There was no advantage of CSII with respect to glycaemic control and neonatal outcomes. The rate of LGA neonates was higher in the CSII group, possibly mediated by excess maternal weight gain, which was more frequent than in women treated with MDI.

Authors+Show Affiliations

Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.Department of Obstetrics, Campus Rudolf-Virchow, Charité Medical Faculty, Humboldt University, Berlin, Germany.Department of Obstetrics, Campus Rudolf-Virchow, Charité Medical Faculty, Humboldt University, Berlin, Germany.Vivantes Neukoelln Hospital, Berlin, Germany.Department of Obstetrics, Campus Rudolf-Virchow, Charité Medical Faculty, Humboldt University, Berlin, Germany.Vivantes Neukoelln Hospital, Berlin, Germany.Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

30698863

Citation

Hauffe, F, et al. "Higher Rates of Large-for-gestational-age Newborns Mediated By Excess Maternal Weight Gain in Pregnancies With Type 1 Diabetes and Use of Continuous Subcutaneous Insulin Infusion Vs Multiple Dose Insulin Injection." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 36, no. 2, 2019, pp. 158-166.
Hauffe F, Schaefer-Graf UM, Fauzan R, et al. Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection. Diabet Med. 2019;36(2):158-166.
Hauffe, F., Schaefer-Graf, U. M., Fauzan, R., Schohe, A. L., Scholle, D., Sedlacek, L., Scherer, K. A., Klapp, C., Ramsauer, B., Henrich, W., Schlembach, D., & Abou-Dakn, M. (2019). Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection. Diabetic Medicine : a Journal of the British Diabetic Association, 36(2), 158-166. https://doi.org/10.1111/dme.13861
Hauffe F, et al. Higher Rates of Large-for-gestational-age Newborns Mediated By Excess Maternal Weight Gain in Pregnancies With Type 1 Diabetes and Use of Continuous Subcutaneous Insulin Infusion Vs Multiple Dose Insulin Injection. Diabet Med. 2019;36(2):158-166. PubMed PMID: 30698863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection. AU - Hauffe,F, AU - Schaefer-Graf,U M, AU - Fauzan,R, AU - Schohe,A L, AU - Scholle,D, AU - Sedlacek,L, AU - Scherer,K A, AU - Klapp,C, AU - Ramsauer,B, AU - Henrich,W, AU - Schlembach,D, AU - Abou-Dakn,M, PY - 2018/11/08/accepted PY - 2019/1/31/entrez PY - 2019/1/31/pubmed PY - 2019/7/16/medline SP - 158 EP - 166 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 36 IS - 2 N2 - AIMS: To compare glycaemic control, maternal and neonatal outcomes in pregnancies with Type 1 diabetes, managed either by continuous subcutaneous insulin infusion, multiple daily insulin injection or switch from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) in early pregnancy. RESEARCH DESIGN AND METHODS: Data from 339 singleton pregnancies were retrospectively reviewed. HbA1c values were measured preconception and in each trimester. In a secondary analysis, use of CSII pre-pregnancy was compared with initiation of CSII during pregnancy. RESULTS: MDI was used in 140 pregnancies (41.3%) and CSII was used in 199 (58.7%), including 34 pregnancies (10.0%) during which the women switched to CSII. In pregnancies during which CSII was used duration of diabetes [median (interquartile range) 16.0 (8.0-23.0) years vs 11.0 (5.5-17.5) years; P<0.001] was longer, and the Institute of Medicine recommendations for appropriate weight gain were exceeded more often (64.8% vs. 50.8%; P=0.01). CSII use and pre-pregnancy BMI were independent predictors of excess weight gain. There was no difference in glucose control, but CSII was associated with higher birth weight [median (interquartile range) 3720 (3365-4100) g vs 3360 (3365-4100) g; P<0.001] and higher large-for-gestational-age (LGA) rate (44.7% vs. 33.6%; P=0.04) than MDI. HbA1c concentration in the third trimester and excess weight gain were predictive of LGA infants [odds ratio 2.33 (95% CI 1.54-3.51); P<0.001 and 1.89 (95% CI 1.02-3.51); P=0.04]. In pregnancies where CSII therapy was initiated in the first trimester and in those with pre-pregnancy use, similar glucose control and outcome was achieved. CONCLUSIONS: There was no advantage of CSII with respect to glycaemic control and neonatal outcomes. The rate of LGA neonates was higher in the CSII group, possibly mediated by excess maternal weight gain, which was more frequent than in women treated with MDI. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/30698863/Higher_rates_of_large_for_gestational_age_newborns_mediated_by_excess_maternal_weight_gain_in_pregnancies_with_Type_1_diabetes_and_use_of_continuous_subcutaneous_insulin_infusion_vs_multiple_dose_insulin_injection_ L2 - https://doi.org/10.1111/dme.13861 DB - PRIME DP - Unbound Medicine ER -