Glycaemic Control and Insulin requirements during pregnancy in women with Type-1 Diabetes Mellitus and Pregnancy Outcome
Abstract
Objectives: The objectives of the study are to evaluate the pattern of insulin requirements and glycaemic control throughout pregnancy in women with Type 1 diabetes mellitus, and to assess the association of maternal glycaemic control with maternal and neonatal outcomes.
Methodology: This is a Retrospective cohort study. Medical records of 135 pregnancies complicated by Type 1 diabetes mellitus (T1D) were scrutinized, and 71 medical records fulfilled the inclusion criteria. Collected data was assessed for patients’ demographics, blood glucose records, insulin requirements in each trimester, and maternal and neonatal outcomes.
Results: Average insulin requirements pre-pregnancy were 56.3 units, which peaked to 62.9 units between 6-8 weeks gestation, and between 9-13 weeks (47.1units), and a second peak between 32-36 weeks (94.4 units) and again at 38 weeks (87.4 units) onwards, the sharpest increment was observed from week 14 to week 32 Maternal complications included impaired awareness of hypoglycemia in 5.6%, ketoacidosis in 2.8%, and pregnancy-induced hypertension/pre-eclampsia in 11.3%. Premature delivery (<37 weeks) occurred in 33.8% of cases. Most births were through c-section, with an average age of 36.5 ± 2.2 weeks and a birth weight of 2425-3100 grams. The neonatal complications included neonatal hypoglycemia in 8.45%, respiratory distress syndrome in 22.54%, congenital anomalies in 11.27%, and intrauterine death (IUD) in 1.4%. There was a significant association between poor pre-pregnancy glycaemic control and congenital anomalies (p< 0.05), but there was no association between maternal glycaemic control, prematurity, neonatal hypoglycaemia, and birth weight (p=NS).
Conclusion: In pregnant women with Type 1 diabetes mellitus, insulin requirements changed with three successive changes of direction. Poor glycaemic control in T1D patients is further complicated by higher rates of maternal and neonatal complications.
