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Fetal overgrowth and preterm delivery in women with type 1 diabetes using insulin pumps or multiple daily injections – a posthoc analysis of the EVOLVE study cohort

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posted on 2023-12-21, 21:32 authored by Ida Holte Thorius, Lise Lotte N. Husemoen, Rikke Baastrup Nordsborg, Amra C. Alibegovic, Mari-Anne Gall, Janne Petersen, Peter Damm, Elisabeth R. Mathiesen

OBJECTIVE: To compare the risk of fetal overgrowth and preterm delivery in pregnant women with type 1 diabetes (T1D) treated with insulin pumps vs. multiple daily injections (MDI) and examine whether possible differences were mediated through improved glycemic control or gestational weight gain during pregnancy.

RESEARCH DESIGN AND METHODS: The risk of pregnancy and perinatal outcomes were evaluated in a cohort of 2003 pregnant women with T1D enrolled from 17 countries in a real-world setting during 2013-2018.

RESULTS: In total, 723 women were treated with pumps and 1280 with MDI. At inclusion (median gestational weeks 8.6 [IQR:7-10]), pump users had lower mean HbA1c (mean±SD: 50.6±9.8 mmol/mol (6.8±0.9%) vs. 53.6±13.8 mmol/mol (7.1±1.3%), P<0.001), longer diabetes duration (18.4 ± 7.8 vs. 14.4 ± 8.2 years, P<0.001), and higher prevalence of retinopathy (35.3% vs. 24.4%, P<0.001). Proportions of large for gestational age (LGA) offspring and preterm delivery were 59.0% vs. 52.2% (adjusted OR 1.36 (95%CI 1.09;1.70), P=0.007) and 39.6% vs. 32.1% (adjusted OR 1.46 (95%CI 1.17;1.82), P<0.001), respectively. The results did not change after adjustment for HbA1c or gestational weight gain.

CONCLUSIONS: Insulin pump treatment in pregnant women with T1D, prior to the widespread use of continuous glucose monitoring or automated insulin delivery, was associated with a higher risk of LGA offspring and preterm delivery compared with MDI in crude and adjusted analyses. This association did not appear to be mediated by differences in glycemic control as represented by HbA1c or by gestational weight gain.

Funding

The Diabetes Pregnancy Registry as part of the EVOLVE study was funded by Novo Nordisk A/S.

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