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Assessment of the effect of pregnancy planning in women with type 1 diabetes treated by insulin pump

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Abstract

Background

Pregnant women with type 1 diabetes (T1D) have high risk of complications despite improved care based on technology advancements.

Objective

To assess the effects of pregnancy planning on fetal and maternal outcomes in T1D women treated with continuous subcutaneous insulin infusion (CSII).

Study design

We retrospectively assessed maternal and neonatal outcomes in T1D women using CSII who had planned or unplanned pregnancies between 2002 and 2018. The study was done in two European countries with similar sustained programs for pregnancy planning over the study period.

Results

Data from 107 pregnancies and newborn babies were collected. Seventy-nine pregnancies (73.8%) had been planned. HbA1c was lower in planned versus unplanned pregnancy before and during all three trimesters of pregnancy (p < 0.0001). Pregnancy planning was associated with a reduction in the occurrence of iatrogenic preterm delivery (RR 0.44, 95% CI 0.23–0.95; p = 0.01). Risk reduction persisted after adjustments for mother’s age above 40 years and preeclampsia. High HbA1c before or during pregnancy was associated with an increased risk of iatrogenic preterm delivery (RR 3.05, 95% CI 1.78–5.22, p < 0.0001). Premature newborns needed intensive care more often than those at term (RR 3.10, 95% CI 1.53–4.31; p = 0.002).

Conclusions

Pregnancy planning in T1D women using CSII was associated with better glucose control and decreased risk of iatrogenic preterm delivery. Hence preconception care also improves pregnancy outcome in patients using an advanced mode of insulin delivery. Planned pregnancies could further benefit from the use of new metrics of glucose control.

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Author notes

  1. Daniela Bruttomesso and Eric Renard have contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Montpellier, France

    Lucie Mourou, Eleonora Vania, Cécile Brunet & Eric Renard

  2. Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France

    Lucie Mourou, Eleonora Vania, Cécile Brunet & Eric Renard

  3. Division of Metabolic Diseases, Department of Medicine DIMED, University of Padova, Padova, Italy

    Valeria Vallone, Silvia Galasso, Federico Boscari & Daniela Bruttomesso

  4. Department of Gynecology and Obstetrics, Montpellier University Hospital, University of Montpellier, Montpellier, France

    Cécile Brunet & Florent Fuchs

  5. Solagna, Italy

    Francesco Cavallin

Authors
  1. Lucie Mourou
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  2. Valeria Vallone
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  3. Eleonora Vania
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Correspondence to Eric Renard.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini.

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Mourou, L., Vallone, V., Vania, E. et al. Assessment of the effect of pregnancy planning in women with type 1 diabetes treated by insulin pump. Acta Diabetol 58, 355–362 (2021). https://doi.org/10.1007/s00592-020-01620-7

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  • DOI: https://doi.org/10.1007/s00592-020-01620-7

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