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Am J Perinatol 2015; 32(14): 1324-1330
DOI: 10.1055/s-0035-1564426
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections of Insulin for the Management of Type 1 Diabetes Mellitus in Pregnancy: Association with Neonatal Chemical Hypoglycemia

James A. Sargent
1   Department of Reproductive Medicine, UC San Diego, San Diego, California
,
Hilary A. Roeder
1   Department of Reproductive Medicine, UC San Diego, San Diego, California
,
Kristy K. Ward
2   Department of Gynecologic Oncology, University of Florida, Jacksonville, Florida
,
Thomas R. Moore
1   Department of Reproductive Medicine, UC San Diego, San Diego, California
,
Gladys A. Ramos
1   Department of Reproductive Medicine, UC San Diego, San Diego, California
› Author Affiliations
Further Information

Publication History

22 July 2015

05 August 2015

Publication Date:
13 October 2015 (online)

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Abstract

Objective We hypothesized that patients with type 1 diabetes mellitus (T1DM) who were managed during their pregnancy with a continuous subcutaneous insulin infusion (CSII) would have a lower incidence of neonatal hypoglycemia (NH) than patients managed with multiple daily injections (MDI) of insulin.

Study Design This was a retrospective cohort of 95 women with T1DM who delivered singleton, term neonates between 2007 and 2014. The primary outcome was incidence of NH (capillary plasma glucose ≤ 45 mg/dL) in the first 24 hours after birth.

Results The incidence of NH was 66.0% (62/95). The NH rate was significantly higher in women managed with CSII versus MDI (62 vs. 38%, p = 0.024). Neonates with NH had a higher birth weight (3,867 ± 658 vs. 3,414 ± 619 g, p = 0.002). When analyzing intrapartum glucose management, mothers of neonates with NH had significantly less time managed on an insulin infusion (median interquartile range 7 [3.5–30.5] vs. 17.5 [2.0–17.5] hours, p = 0.014). In multivariable analysis, only maternal body mass index (BMI) (p = 0.035) and time on an insulin infusion (p = 0.043) were significantly associated with NH.

Conclusion In our population of patients with T1DM, CSII was more prevalent in the NH group; however, when controlling for other factors, intrapartum glucose management and early maternal BMI were the only variables associated with NH.

Keywords

continuous subcutaneous insulin infusion pump - neonatal hypoglycemia - pregnancy - type 1 diabetes mellitus

Notes

This study was approved by the UCSD Human Research and Protections Program, IRB# 111310. The findings in this article were presented as a poster at the 35th Annual Meeting, The Pregnancy Meeting, San Diego, CA, February 2–7, 2015.


 

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