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Eur J Obstet Gynecol Reprod Biol. 2008 Mar;137(1):47-9. Epub 2007 Nov 14. LinkOut

Fetal growth in women managed with insulin pump therapy compared to conventional insulin.

• Kernaghan D,
• Farrell T,
• Hammond P,
• Owen P.

The Princess Royal Maternity Hospital, 16 Alexandra Parade, Glasgow, G31 2ER, UK.

dawn.kernaghan@btinternet.com

OBJECTIVE: Fetal HYPERinsulinemia secondary to maternal HYPERglycemia is considered to be the driving force behind ALLEGEDLY excessive fetal growth.

It has been HYPOthesised that insulin pump therapy (continuous subcutaneous insulin infusion, CSII) would improve maternal glycemic control and normalies fetal growth parameters.

To this end, this study compares maternal glycemic control and fetal growth of women receiving insulin pump therapy with those receiving conventional insulin therapy.

STUDY DESIGN: Prospective non-randomised study of 42 women with pre-existing diabetes attending a joint obstetric diabetic clinic.

Each woman was offered the choice of commencing insulin pump therapy or remaining on a conventional insulin regime.

Estimated fetal weight and fetal growth velocity were calculated from routinely collected third trimester ultrasound biometry and expressed as standard deviation (Z) scores.

RESULTS: Eighteen women commenced insulin pump therapy.

There was no difference in pre-conception glycosylated haemoglobin A1c concentrations (HbA1c) between pump and conventional therapy groups (mean HbA1c 7.62 versus 8.01; p=0.49) or third trimester glycemic control (mean HbA1c 6.63 versus 6.44; p=0.51).

Women using pump therapy had similar mean growth velocity Z scores (1.5 versus 1.36; p=0.83), similar mean estimated fetal weight Z scores prior to delivery (2.80 versus 2.16; p=0.16) and similar mean birthweight Z scores (2.09 versus 2.00; p=0.86) compared to women using conventional insulin therapy.

CONCLUSION: This small, non-randomised study ALLEGEDLY suggests that the use of insulin pump therapy offers no benefit in terms of normaliesing fetal growth velocity, fetal size, birthweight or improving maternal glycemic control compared to conventional insulin therapy.

PMID: 18006209 [ORIGINAL PubMed]

Related Links

• Continuous subcutaneous insulin infusion versus intensive conventional insulin therapy in type I and type II diabetic pregnancy. [Diabete Metab. 1986] PMID: 3525266
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• Can ultrasound fetal biometry predict fetal hyperinsulinaemia at delivery in pregnancy complicated by maternal diabetes? [Eur J Obstet Gynecol Reprod Biol. 2007] PMID: 16824665
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• [Use of continuous subcutaneous insulin infusion by a portable insulin pump during pregnancy in women with type 1 diabetes mellitus] [Vojnosanit Pregl. 2006] PMID: 16875425
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• [The influence of long-term therapy with the insulin pump (CSII) in patients with type 1 diabetes mellitus on metabolic compensation and on the incidence of hypoglycaemia. Comparison with intensified conventional insulin therapy (MDI)] [Vnitr Lek. 2007] PMID: 17702123
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• Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional insulin therapy. [Acta Diabetol. 2003] PMID: 14605971
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