Glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes according to the type of basal insulin
Por:
Chico, A, Herranz, L, Corcoy, R, Ramirez, O, Goya, MM, Bellart, J, Gonzalez-Romero, S, Codina, M, Sanchez, P, Cortazar, A, Acosta, D, Picon, MJ, Rubio, JA, Megia, A, Sancho, MA, Balsells, M, Sola, E, Gonzalez, NL, Lopez-Lopez, J
Publicada:
1 nov 2016
Resumen:
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 (HbA(1c)) 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Filiaciones:
Chico, A:
Hosp Santa Creu & Sant Pau, Dept Endocrinol, Av St Antoni Maria Claret 167, Barcelona 08025, Spain
CIBER BBN, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Av St Antoni Maria Claret 167, Barcelona 08025, Spain
Herranz, L:
Hosp La Paz, Dept Endocrinol, Castellana 261, Madrid 28046, Spain
Corcoy, R:
Hosp Santa Creu & Sant Pau, Dept Endocrinol, Av St Antoni Maria Claret 167, Barcelona 08025, Spain
CIBER BBN, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Av St Antoni Maria Claret 167, Barcelona 08025, Spain
Ramirez, O:
Hosp Materno Infantil Canarias, Dept Obstet & Gynecol, Av Maritima Sur S-N, Las Palmas Gran Canaria 35001, Las Palmas, Spain
Goya, MM:
Hosp Vail Hebron, Dept Obstet, Passeig Vail Hebron 119-129, Barcelona 08035, Spain
Bellart, J:
Hosp Clin Barcelona, Dept Obstet & Gynecol, Sabino Arana 1, Barcelona 08028, Spain
Gonzalez-Romero, S:
Hosp Reg Malaga, Dept Endocrinol, Av Carlos Haya S-N, Malaga 29010, Spain
Codina, M:
Hosp Son Espases, Dept Endocrinol, Carretera Valldemossa 79, Palma De Mallorca 07120, Illes Balears, Spain
Sanchez, P:
Hosp Gregorio Maranon, Dept Endocrinol, Calle Dr Esquerdo 46, Madrid 28007, Spain
Cortazar, A:
Hosp Cruces, Dept Endocrinol, Plaza Cruces 12, Baracaldo 48903, Vizcaya, Spain
CIBERDEM, Barcelona, Spain
Acosta, D:
Hosp Virgen Rocio, Dept Endocrinol, Av Manuel Siurot S-N, Seville 41013, Spain
Picon, MJ:
Hosp Virgen Victoria, Dept Endocrinol, Campus Teatinos S-N, Malaga 29010, Spain
Rubio, JA:
Hosp Principe Asturias, Dept Endocrinol, Carretera Alcala Meco S-N, Madrid 28805, Spain
Megia, A:
CIBERDEM, Barcelona, Spain
Hosp Univ Tarragona Joan XXIII, Dept Endocrinol, C Dr Mallafre Guasch 4, Tarragona 43005, Spain
IISPV, Madrid, Spain
Univ Rovira & Virgili, C Dr Mallafre Guasch 4, Tarragona 43005, Spain
Sancho, MA:
Hosp Clin Lozano Blesa, Dept Endocrinol, Ave San Juan Bosco 15, Zaragoza 50009, Spain
Balsells, M:
Hosp Mutua Terrassa, Dept Endocrinol, Placa Doctor Robert 5, Barcelona 08221, Spain
Sola, E:
Hosp Dr Peset, Dept Endocrinol, Gaspar Aguilar 90, Valencia 46017, Spain
Gonzalez, NL:
Hosp Clin, Dept Obstet & Gynecol, Ctra Ofra S-N, Tenerife 38320, Spain
Lopez-Lopez, J:
Hosp Virgen Salud, Dept Endocrinol, Ave Barber 30, Toledo 45071, Spain
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