Document Detail


Pre-pregnancy care and pregnancy outcomes in type 1 diabetes mellitus: a comparison of continuous subcutaneous insulin infusion and multiple daily injection therapy.
MedLine Citation:
PMID:  24142539     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
K J Neff; R Forde; C Gavin; M M Byrne; R G R Firth; S Daly; F M McAuliffe; M Foley; M Coffey; S Coulter-Smith; B T Kinsley
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-22
Journal Detail:
Title:  Irish journal of medical science     Volume:  -     ISSN:  1863-4362     ISO Abbreviation:  Ir J Med Sci     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7806864     Medline TA:  Ir J Med Sci     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Dublin Diabetes in Pregnancy Centre, Mater Misericordiae University Hospital, 30 Eccles St, Dublin 7, Republic of Ireland.
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