Mathiesen_DC21-0472_Appendix_revised_10May2021.pdf (87.37 kB)

Risk of Major Congenital Malformations or Perinatal or Neonatal Death With Insulin Detemir Versus Other Basal Insulins in Pregnant Women With Preexisting Diabetes: The Real-World EVOLVE Study

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posted on 30.07.2021, 14:00 by Elisabeth R. Mathiesen, Norsiah Ali, Amra C. Alibegovic, Eleni Anastasiou, Katarzyna Cypryk, Harold de Valk, Jorge Dores, Fidelma Dunne, Mari-Anne Gall, Santiago Duran Garcia, Hélène P. Hanaire, Lise Lotte N. Husemoen, Marina Ivanišević, Hans-Peter Kempe, David R. McCance, Peter Damm

OBJECTIVE: To compare the risk of severe adverse pregnancy complications in women with pre-existing diabetes.

RESEARCH DESIGN AND METHODS: Multinational, prospective cohort study to assess the prevalence of newborns free from major congenital malformations, perinatal or neonatal death (primary endpoint) following treatment with insulin detemir (detemir) vs other basal insulins.

RESULTS: Of 1,457 women included, 727 received detemir and 730 received other basal insulins. The prevalence of newborns free from major congenital malformations, perinatal or neonatal death was similar between detemir (97.0%) and other basal insulins (95.5%) (crude risk difference 0.015 [95% CI −0.01,0.04]; adjusted risk difference −0.003 [95% CI −0.03,0.03]). The crude prevalence of ≥1 congenital malformation (major + minor) was 9.4% vs 12.6%, with a similar risk difference before (−0.032 [95% CI −0.064,0.000]) and after (−0.036 [95% CI –0.081,0.009]) adjustment for confounders. Crude data showed lower maternal HbA1c during the first trimester (6.5% vs 6.7% [48 vs 50 mmol/mol]; estimated mean difference −0.181 [95% CI −0.300,−0.062]) and the second trimester (6.1% vs 6.3% [43 vs 45 mmol/mol]; −0.139 [95% CI −0.232,−0.046]), and a lower prevalence of major hypoglycemia (6.0% vs 9.0%; risk difference −0.030 [95% CI −0.058,−0.002]), pre-eclampsia (6.4% vs 10.0%; −0.036 [95% CI −0.064,−0.007]), and stillbirth (0.4% vs 1.8%; −0.013 [95% CI −0.024,−0.002],) with detemir compared to other basal insulins. However, differences were not significant post-adjustment.

CONCLUSION: Insulin detemir was associated with a similar risk to other basal insulins of major congenital malformations, perinatal or neonatal death, hypoglycemia, pre-eclampsia and stillbirth.

Funding

The EVOLVE study, including study design, data collection, analysis, and interpretation, was funded by Novo Nordisk A/S. Medical writing and editorial assistance were also sponsored by Novo Nordisk A/S.

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