engleski

Pregnancy with type I diabetes treated with an insulin pump. Risks for large for gestational age infants and alternating basal-bolus insulin ratio

BACKGROUND AND AIMS: The aim of this study was to identify parameters that contribute the most to the development of large for gestational age (LGA) infants in a cohort of patients with type 1 diabetes mellitus (T1DM) treated with an insulin pump during pregnancy. Furthemore, basal and bolus insulin changes during pregnancy were also evaluated. METHODS: The data of patients was retrospectively analyzed. Inclusion criteria were HbA1c ≤7.0% (53mmol/mol) and BMI<25kg/m2 at the time of conception, duration of T1DM for more than 2 years and treatment with insulin pump for at least 3 months prior to conception. A total of 14 patients were included. Patient characteristics are shown in Table 1. Statistical analysis was performed using Wilcoxon signed ranks test and linear regression. RESULTS: Among several analyzed parameters, only HbA1c in the last trimester was extracted as a significant predictor of birth weight (R square=0.653). Furthermore, preconception maternal body weight correlated with HbA1c in the last trimester (p=0.026, r=0.592). Regarding insulin changes, total daily insulin dose (TDI) increased by 33% from the conception to the last trimester, 34.7U (13.4-50.6) and 46.2 U (17.5-87.0), respectively (Figure 1, Table 1). Most of the TDI increase was attributed to the rise of bolus insulin while basal insulin remained fairly constant with basal-bolus insulin ratio changing from 52/48 to 39/61. CONCLUSIONS: Preconception body weight and optimal glycemic control during pregnancy, especially in the last trimester, are essential for reducing risk of LGA neonates. Regarding insulin changes, there should be emphasis on increase of bolus insulin as pregnancy progresses

type 1 diabetes mellitus ; insulin pump ; pregnancy ; large for gestational age

nije evidentirano