Beksac M S, Fadiloglu E, Tanacan A
Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatal Medicine, Ankara, Turkey.
Acta Endocrinol (Buchar). 2020 Jan-Mar;16(1):53-58. doi: 10.4183/aeb.2020.53.
To evaluate obstetric and neonatal outcomes of patients with type 1 diabetes mellitus (T1DM) and compare multidose injection (MDI) and continuous subcutaneous insulin infusion (CSII).
Retrospective study of 53 pregnant patients with T1DM reaching at least 24 gestational week.
Fourteen patients (26.4%) hospitalized for insulin dose regulation. Ten patients had hypertensive diseases. Perinatal mortality occurred in 2 neonates owing to cardiac malformations. Neonatal hypoglycemia, small for gestational age, large for gestational age, and neonatal jaundice were demonstrated in 8, 4, 12 and 19 newborns, respectively. Sixteen newborns were admitted to the NICU for various reasons. Congenital malformations were detected in 7 newborns (6 cardiovascular and 1 central nervous system anomaly). Despite lack of statistical significance, total daily insulin doses were higher in the MDI group than in the CSII group with doses of 62 IU (18-166) and 51 IU (20-114), respectively (p=0.119). Gestational and perinatal outcomes also showed no statistical significance. However, all congenital abnormalities and perinatal deaths occurred in the MDI group.
T1DM in pregnancy is a challenging problem in terms of having better obstetric and perinatal results. CSII may be used safely instead of MDI in appropriate patients.
评估1型糖尿病（T1DM）患者的产科和新生儿结局，并比较多次皮下注射（MDI）和持续皮下胰岛素输注（CSII）。
对53例孕周至少达到24周的T1DM孕妇进行回顾性研究。
14例患者（26.4%）因胰岛素剂量调整住院。10例患者患有高血压疾病。2例新生儿因心脏畸形发生围产期死亡。分别有8例、4例、12例和19例新生儿出现低血糖、小于胎龄儿、大于胎龄儿和新生儿黄疸。16例新生儿因各种原因入住新生儿重症监护病房（NICU）。7例新生儿检测出先天性畸形（6例心血管畸形和1例中枢神经系统畸形）。尽管无统计学意义，但MDI组每日胰岛素总剂量高于CSII组，分别为62 IU（18 - 166）和51 IU（20 - 114）（p = 0.119）。妊娠和围产期结局也无统计学意义。然而，所有先天性异常和围产期死亡均发生在MDI组。
妊娠合并T1DM在获得更好的产科和围产期结果方面是一个具有挑战性的问题。在合适的患者中，可安全使用CSII替代MDI。
