A Chico1, L Herranz2, R Corcoy3, O Ramírez4, M M Goya5, J Bellart6, S González-Romero7, M Codina8, P Sánchez9, A Cortázar10, D Acosta11, M J Picón12, J A Rubio13, A Megía14, M A Sancho15, M Balsells16, E Solá17, N L González18, J López-López19. 1. Department of Endocrinology, Hospital Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; CIBER-BBN, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Av. Sant Antoni Maria Claret 167, 08025 Barcelona, Spain. Electronic address: achicob@santpau.cat. 2. Department of Endocrinology, Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. Electronic address: lucherranz.hulp@salud.madrid.org. 3. Department of Endocrinology, Hospital Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; CIBER-BBN, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Av. Sant Antoni Maria Claret 167, 08025 Barcelona, Spain. Electronic address: rcorcoy@santpau.cat. 4. Department of Obstetrics and Gynecology, Hospital Materno-Infantil de Canarias, Av. Marítima Sur, s/n, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain. Electronic address: oramirezg@sego.es. 5. Department of Obstetrics, Hospital Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: mariagoya@mac.com. 6. Department of Obstetrics and Gynecology, Hospital Clinic, Sabino Arana, 1,08028 Barcelona, Spain. Electronic address: jbellart@clinic.ub.es. 7. Department of Endocrinology, Hospital Regional de Málaga, Av. Carlos Haya s/n, 29010 Malaga, Spain. Electronic address: stellagoro@movistar.es. 8. Department of Endocrinology, Hospital Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Illes Balears, Spain. Electronic address: mcodinam@binimelis.jazztel.es. 9. Department of Endocrinology, Hospital Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain. Electronic address: psanchezga.hgugm@salud.madrid.org. 10. Department of Endocrinology, Hospital Cruces, Bilbao, Plaza de Cruces, 12, 48903 Barakaldo, Vizcaya, Spain; CIBERDEM, Spain. Electronic address: alicia.cortazargalarza@osakidetza.net. 11. Department of Endocrinology, Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013 Sevilla, Spain. Electronic address: dacostadelgado@gmail.com. 12. Department of Endocrinology, Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain. Electronic address: mjpiconcesar@gmail.com. 13. Department of Endocrinology, Hospital Príncipe de Asturias, Carretera Alcalá-Meco, s/n, 28805 Alcalá de Henares, Madrid, Spain. Electronic address: jarubiogarcia@gmail.com. 14. CIBERDEM, Spain; Department of Endocrinology, Hospital Universitari de Tarragona Joan XXIII, C/Dr. Mallafrè Guasch, 4, 43005 Tarragona, Spain; IISPV, Spain; Universitat Rovira I Virgili, C/Dr. Mallafrè Guasch, 4, 43005 Tarragona, Spain. Electronic address: ana.megia@gmail.com. 15. Department of Endocrinology, Hospital Clinico Lozano Blesa, Avenida San Juan Bosco, 15, 50009 Zaragoza, Spain. Electronic address: ma.sancho@comz.org. 16. Department of Endocrinology, Hospital Mutua de Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain. Electronic address: 23591mbc@comb.cat. 17. Department of Endocrinology, Hospital Dr Peset, Gaspar Aguilar 90, 46017 Valencia, Spain. Electronic address: eva.sola@uv.es. 18. Department of Obstetrics and Gynecology, Hospital Clinico, Ctra. Ofra S/N La Cuesta 38320 La Laguna, Tenerife, Spain. Electronic address: ngonzalezg@sego.es. 19. Department of Endocrinology, Hospital Virgen de la Salud, Avenida de Barber, 30, 45071 Toledo, Spain. Electronic address: jololo@sescam.jccm.es.
Abstract
OBJECTIVE: To examine the potential role of the type of basal insulin on glycemic control and maternal and foetal outcomes in pregnant women with type 1 diabetes (T1DM). STUDY DESIGN: Retrospective cohort study of pregnancies attended at 18 Spanish tertiary hospitals. INCLUSION CRITERIA: T1DM, singleton pregnancies, delivery between 2002-2010, and use of the same basal and prandial insulin from before pregnancy until delivery. RESULTS: A total of 1534 pregnancies were included. The basal insulin most commonly used was Neutral Protamine Hagedorn (NPH) (51.7%), followed by glargine (23.2%) and continuous subcutaneous insulin infusion (CSII) (21.1%). CSII users had longer diabetes duration. Multiple logistic regression analysis showed that CSII was independently associated with lower doses of insulin, higher glycated haemoglobin (HbA1c) in all trimesters, and higher rates of miscarriage, preterm birth and neonatal hypoglycemia. Glargine was related to a higher risk of preterm birth and a small-for-gestational age infant (SGA). The odds ratios (OR) of the associations between insulin type and clinical outcomes (from 0.642 to 4.894) have a relevant magnitude. CONCLUSIONS: In this observational study of pregnant women with T1DM, the type of basal insulin was independently associated with metabolic variables and foetal outcomes.
OBJECTIVE: To examine the potential role of the type of basal insulin on glycemic control and maternal and foetal outcomes in pregnant women with type 1 diabetes (T1DM). STUDY DESIGN: Retrospective cohort study of pregnancies attended at 18 Spanish tertiary hospitals. INCLUSION CRITERIA: T1DM, singleton pregnancies, delivery between 2002-2010, and use of the same basal and prandial insulin from before pregnancy until delivery. RESULTS: A total of 1534 pregnancies were included. The basal insulin most commonly used was Neutral Protamine Hagedorn (NPH) (51.7%), followed by glargine (23.2%) and continuous subcutaneous insulin infusion (CSII) (21.1%). CSII users had longer diabetes duration. Multiple logistic regression analysis showed that CSII was independently associated with lower doses of insulin, higher glycated haemoglobin (HbA1c) in all trimesters, and higher rates of miscarriage, preterm birth and neonatal hypoglycemia. Glargine was related to a higher risk of preterm birth and a small-for-gestational age infant (SGA). The odds ratios (OR) of the associations between insulin type and clinical outcomes (from 0.642 to 4.894) have a relevant magnitude. CONCLUSIONS: In this observational study of pregnant women with T1DM, the type of basal insulin was independently associated with metabolic variables and foetal outcomes.
Authors: Roy Gavin Stone; Paul Scully; Emma Troy; Yvonne Moloney; Anne Quinn; Eoin Noctor; Orla Neylon; John Slevin; Annemarie Murphy; Clodagh O'Gorman Journal: BMJ Open Diabetes Res Care Date: 2020-04