Use of insulin pumps tied to preterm delivery, fetal overgrowth in pregnant women with type 1 diabetes: Study

The study, published in Diabetes Care, stated, “This association did not appear to be mediated by differences in glycemic control as represented by gestational weight gain or by HbA1c.”

“Proportions of LGA offspring and preterm delivery were higher among pump users compared with MDI users (OR, 1.36 for LGA and OR, 1.46 for preterm delivery),” the study researchers reported.

Previous studies have shown that fetal overgrowth is associated with higher maternal glycemic levels during pregnancy. Ida Holte Thorius, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark, and colleagues aimed to compare the risk of preterm delivery and fetal overgrowth in pregnant women with type 1 diabetes (T1D) treated with insulin pumps versus multiple daily injections (MDI). They also examined whether possible differences were mediated through improved glycemic control or gestational weight gain during pregnancy.

For this purpose, the research team evaluated the risk of pregnancy and perinatal outcomes in a cohort of 2,003 pregnant women with T1D enrolled from 17 countries in a real-world setting during 2013–2018. 723 women were treated with pumps and 1,280 with MDI.

The study led to the following findings:

• At inclusion (median gestational weeks 8.6 [interquartile range 7–10]), pump users had lower mean HbA1c (mean 50.6 mmol/mol vs. 53.6 ± 13.8 mmol/mol), longer diabetes duration (18.4 versus 14.4 years), and higher prevalence of retinopathy (35.3% versus 24.4%).
• Proportions of large for gestational age offspring and preterm delivery were 59.0% vs. 52.2% (adjusted odds ratio [OR] 1.36) and 39.6% vs. 32.1% (adjusted OR 1.46), respectively.
• The results did not change after adjustment for HbA1c or gestational weight gain.

In conclusion, insulin pump treatment in pregnant women with type 1 diabetes, before the widespread use of continuous glucose monitoring or automated insulin delivery, was linked with a higher risk of LGA offspring and preterm delivery compared with MDI in crude and adjusted analyses.

This association was not attenuated after adjustment for gestational weight gain or HbA1c.

Reference:

Ida Holte Thorius, Lise Lotte N. Husemoen, Rikke Baastrup Nordsborg, Amra C. Alibegovic, Mari-Anne Gall, Janne Petersen, Peter Damm, Elisabeth R. Mathiesen; Fetal Overgrowth and Preterm Delivery in Women With Type 1 Diabetes Using Insulin Pumps or Multiple Daily Injections: A Post Hoc Analysis of the EVOLVE Study Cohort. Diabetes Care 23 February 2024; 47 (3): 384–392. https://doi.org/10.2337/dc23-1281