Glucose control in early pregnancy influences obstetric outcomes in T1D

The course of pregnancy and obstetric outcomes in women with type 1 diabetes (T1D) are dependent on planning and glycated haemoglobin (HbA1c) levels in early pregnancy rather than on the mode of insulin delivery, a study has found.

The study included 209 pregnant Caucasian women with T1D, among whom 95 were treated with multiple daily insulin injections (MDI) and 114 with continuous subcutaneous insulin infusion (CSII). Compared with MDI users, CSII users were older (p=0.0373), had early T1DM onset (p=0.047), and more often planned pregnancy (p=0.032). They also were more likely to reach the target value of HbA1c (p=0.008).

HbA1c levels at the first and second trimester were lower among CSII vs MDI users (6.83 percent vs 7.52 percent; p=0.01 and 6.17 percent vs 6.57 percent; p=0.009, respectively), while that at the third trimester as well as the total HbA1c change were comparable.

The incidence of pregnancy loss, such as abortions, foetal and neonatal death, did not differ between the groups. Among those who experienced pregnancy loss, prepregnancy HbA1c was only numerically higher among MDI vs CSII users (8.41 percent vs 7.22 percent; p=0.517). There were no differences seen in gestational age at delivery, mode of delivery, neonatal birth weight, and rate of macrosomy, among others. A higher Apgar score was noted among the CSII users (8.63 vs 8.03 percent; p=0.047); however, the proportion of neonates with scores <7 points was similar.

Among the women who planned pregnancy, HbA1c in the first trimester and the composite outcome of pregnancy loss were significantly lower for CSII users than MDI treated women.

Lack of pregnancy planning and a high HbA1c level in the first trimester were independent predictors of both large for gestational age (odds ratio [OR], 4.99, 95 percent confidence interval [CI], 1.12–21.0; p=0.033 and OR, 3.02, 95 percent CI, 1.19–7.65; p=0.019, respectively) and macrosomia (OR, 8.43, 95 percent CI, 1.36–51.93; p=0.021 and OR, 5.47, 95 percent CI, 1.77–16.87; p=0.003, respectively).