1. Falling Insulin Requirement in Pregnant Women With Diabetes Delivering Preterm: Prevalence, Predictors, and Consequences
- Author
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Julie C Søholm, Nicoline C Do, Marianne Vestgaard, Björg Ásbjörnsdóttir, Sidse K Nørgaard, Berit W Pedersen, Lone Storgaard, Birgitte B Nielsen, Pernille Holmager, Lene Ringholm, Peter Damm, and Elisabeth R Mathiesen
- Subjects
Placenta ,Endocrinology, Diabetes and Metabolism ,Biochemistry (medical) ,Clinical Biochemistry ,Infant, Newborn ,Pregnancy Outcome ,Biochemistry ,Asphyxia ,Diabetes Mellitus, Type 1 ,Endocrinology ,Diabetes Mellitus, Type 2 ,Pregnancy ,Prevalence ,Humans ,Insulin ,Premature Birth ,Female ,Pregnant Women ,Prospective Studies - Abstract
Context Falling insulin requirements often lead to considerations of whether a pregnancy can continue safely or if delivery is indicated. Objective To evaluate prevalence and predictors of falling insulin requirements in pregnant women with preexisting diabetes delivering preterm and to explore the relationship to fetal asphyxia and neonatal morbidity. Methods A prospective cohort study of 101 consecutive singleton pregnant women with preexisting diabetes delivering preterm Results In total, 27% (27/101) experienced falling insulin requirements of median 30% (interquartile range 24-40) before delivery. In all women with type 1 diabetes, the prevalence was 37% (25/68), whereas it was 43% (24/56) in those with indicated preterm delivery and 6% (2/33) among women with type 2 diabetes. In women with type 1 diabetes and indicated preterm delivery, falling insulin requirements were first identified at 34 + 5 (33 + 6-35 + 4) weeks + days and delivery occurred 3 (1-9) days later. Gestational age at delivery, prevalence of suspected fetal asphyxia, and neonatal morbidity were similar in women with and without falling insulin requirements. Neither glycemic control, nausea, or preeclampsia was associated with falling insulin requirement. Conclusion Falling insulin requirements often preceded preterm delivery in women with type 1 diabetes, foremost when preterm delivery was indicated, but was not related to fetal asphyxia or neonatal morbidity. Whether falling insulin requirements in late pregnancy are a warning sign of placental insufficiency or mainly reflects variations in normal physiology needs further investigation.
- Published
- 2022