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Irish Journal of Medical Science (1971 -)

, Volume 183, Issue 3, pp 397–403 | Cite as

Pre-pregnancy care and pregnancy outcomes in type 1 diabetes mellitus: a comparison of continuous subcutaneous insulin infusion and multiple daily injection therapy

  • 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
Original Article

Abstract

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.

Keywords

Diabetes Pregnancy Pre-pregnancy planning Insulin infusion 

Notes

Acknowledgments

The authors would like to acknowledge the Eithne Coleman, Laura O’Shea and Ailbhe McCarthy who contributed to the care of the women in this study, and who also aided in data collection. This clinical research project did not receive any specific funding.

Conflict of interest

The authors have no conflicts of interest to disclose. No competing financial interests exist.

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Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  • K. J. Neff
    • 1
    • 2
    • 3
  • R. Forde
    • 1
  • C. Gavin
    • 1
    • 3
  • M. M. Byrne
    • 1
    • 4
  • R. G. R. Firth
    • 1
    • 3
  • S. Daly
    • 1
    • 2
  • F. M. McAuliffe
    • 1
    • 3
    • 5
  • M. Foley
    • 1
    • 3
  • M. Coffey
    • 1
    • 3
  • S. Coulter-Smith
    • 1
    • 4
  • B. T. Kinsley
    • 1
    • 2
  1. 1.Dublin Diabetes in Pregnancy CentreMater Misericordiae University HospitalDublin 7Republic of Ireland
  2. 2.Coombe Women and Infants University HospitalDublin 8Republic of Ireland
  3. 3.National Maternity HospitalDublin 2Ireland
  4. 4.The Rotunda HospitalDublin 1Republic of Ireland
  5. 5.UCD Obstetrics and Gynaecology, School of Medicine and Medical ScienceUniversity College DublinDublin 4Republic of Ireland

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