Pregnancy Outcomes in Women with Type 1 Diabetes Treated with Long Acting Insulin Analogs. A Case Control Study
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Дата
2010-10
Автори
Todorova – Ananieva, K.
Konova, E.
Guenova, M.
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Издател
Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia
Резюме
The aim was to evaluate and compare the pregnancy outcome in
women with type1 diabetes (T1D) intensively treated with long acting insulin or insulin
analogs. A prospective two-year case control study in ninety pregnant women
with T1D was performed. The intensifi ed treatment consisted of insulin aspart as
bolus insulin and long acting insulin as basal. Women were divided into three groups
according to the basal insulin: n1=30 treated with NPH insulin, n2=30 treated with
insulin detemir and n3=30 treated with insulin glargine. Participants were matched
for age, duration of diabetes, BMI, HbA1c before pregnancy parity, number of previous
pregnancies and abortions. Metabolic control, diabetic complications, severe hypoglycemic
episodes and pregnancy induced hypertension and preeclampsia were
registered. Perinatal mortality, stillbirth, macrosomia, weeks and route of delivery and
neonatal complications were also recorded. Statistical methods: ANOVA – with multiple
comparison and chi square test have been used. No statistically signifi cant difference
in mean values for age, diabetes duration, BMI, parity, and number of previous
pregnancies. No differences were observed in pre-prandial, postprandial glucose
and HbA1c levels in early pregnancy (HbA1c n1 = 7.3 ± 0.8%, n2 = 6.9 ± 0.9%, n3
= 7.1 ± 0.8%, P = 0.7). No differences were observed in postprandial glucose and
Hba1c in late pregnancy (HbA1c n1 = 7.8 ± 0.3%, n2 = 7.3 ± 0.6%, n3 = 7.7 ± 0.7%,
P = 0.06) as well. The level of preprandial glucose in late pregnancy was lowest in
fi rst group (n1 = 4.5 ± 1.4 mmol/l, n2 = 6.6 ± 1.1 mmol/l, n3 = 6.9 ± 0.8 mmol/l, P =
0.0001). The doses of short acting insulin were signifi cantly higher in the fi rst group
in early (n1 = 25.9 ± 34.5 U/kg, n2 = 17.0 ± 25.3 U/kg, n3 = 19.6 ± 26.7%, P = 0.004)
and in late pregnancy (n1 = 41.1 ± 20.0 U/kg n2 = 26.1 ± 12.9 U/kg, n3 = 21.9 ± 10.1
U/kg, P = 0.0001). There were no differences in the dose of long acting insulin in
early pregnancy between the groups, but in late pregnancy the dose in n1 group was
statistically lower in comparison to the other two groups (n1 = 16.0 ± 6.8 U/kg n2 = 21.4 ± 8.2 U/kg, n3 = 29.7 ± 6.6 U/kg, P = 0.001). Severe hypoglycemic episodes in
the fi rst group were observed at rate 16% (P = 0.03). There were no differences in
frequency of hypoglycemic episodes between groups n2 and n3. Caesarean section
was the main choice in all groups. There was statistically signifi cant difference in the
time of delivery in the third group compared to the other groups (n1 = 36.7±1.1 week
n2 = 36.2 ± 1.2 week, n3 = 37.5 ± 0.7 week, P = 0.001). The newborn’s body weight in
third group was statistically higher than in the other two groups (n3 =3623.9 ± 527.8
g, n1 = 3364.3 ± 662.4 g, n2 = 3076.7 ± 798.7 g, P = 0.02). The incidence of Respiratory
Distress Syndrome was higher in the fi rst group (P = 0.04). The frequency of
neonatal hypoglycemia was higher in the third group (P = 0.003). The frequency of
spontaneous abortion and stillbirths was higher in the third group, but without statistical
signifi cance. The evaluations of risk factors could not establish relationship
between the observed fetal complications and the insulin treatment. It is concluded
that the treatment with long acting insulin analogs during pregnancy shows similar
maternal effi cacy and safety. In terms of fetal complications and safety, the conduct
of longer treatment trials in larger groups is needed.
Описание
Address for correspondence:
Katya Todorova – Ananieva MD, PhD
High Risk Pregnancy Department
Specialized Hospital of Obstetrics and Gynecology
2 Zdrave Str.
1431, Sofi a, Bulgaria ****
tel. 00359 2851 7222 ****
tel.00359 2851 7222 ****
e-mail: todorova_kate@abv.bg
Ключови думи
low-impact insulin analogues, diabetes mellitus type 1, pregnancy
Цитирания
K. Todorova – Ananieva, E. Konova, M. Guenova. Pregnancy Outcomes in Women with Type 1 Diabetes Treated with Long Acting Insulin Analogs. A Case Control Study - Acta Medica Bulgarica, 37, 2010, № 2, 21-31.