(8.16) Glycemic Control And Insulin Requirements Throughout Pregnancy In Women With Type 1 Diabetes Mellitus And Pregnancy Outcome.

Background: The prevalence of diabetes in pregnancy has been increasing worldwide. The association of poor glycemic control with unexpected perinatal outcomes has been established.  In women with Type 1 diabetes mellitus (T1D), precise metabolic control is important both before and during pregnancy to reduce pregnancy complications.  Maintenance of good glycaemic control is difficult because insulin requirements continuously change throughout pregnancy.

The aim of this study is to determine glycaemic control, insulin requirement of women with T1D throughout pregnancy and to correlate maternal glycaemic control with maternal and perinatal outcomes.

 

Methods:

This is a Retrospective cohort study.  Medical records of 135 pregnancies complicated by T1D were scrutinized and 71 medical records fulfilled the inclusion criteria. Collected data was assessed for patients’ demographics, blood glucose records, insulin requirements during each trimester, and maternal and neonatal outcomes.

Results:

Average insulin requirements pre-pregnancy were 56.3 units, which peaked to 62.9 units between 6-8 weeks gestation, a nadir between 9-13 weeks(47.1units), and a second peak between 32-36 weeks (94.4 units) and again nadir at 38 weeks (87.4 units) onwards, the sharpest increment was observed from week 14 to week 32 (figure1) Maternal complications included impaired awareness of hypoglycaemia in 5.6%, ketoacidosis in 2.8%, and pregnancy-induced hypertension/pre-eclampsia in 11.3%. Premature delivery (< 37 weeks) occurred in 33.8% of cases.

 Neonatal complications included neonatal hypoglycaemia in 8.45%, respiratory distress syndrome in 22.54%, congenital anomalies in 11.27%, and intrauterine death (IUD) in 1.4%.

Pre-pregnancy poor glycaemic control was significantly associated with congenital anomalies (p< 0.05) but no association was observed between maternal glycaemic control, premature delivery, neonatal hypoglycaemia, and birth weight (p=NS).

Discussion/Conclusion:

Pregnant women with T1D had changes in insulin requirements with three successive changes of direction. Poor glycaemic control in T1D patients is complicated by higher rates of maternal and neonatal complications.