Effect of pregnancy planning on maternal and neonatal outcomes in type 1 diabetic women with type 1 diabetes treated by continuous subcutaneous insulin infusion - DUMAS - Dépôt Universitaire de Mémoires Après Soutenance Access content directly
Master Thesis Year : 2018

Effect of pregnancy planning on maternal and neonatal outcomes in type 1 diabetic women with type 1 diabetes treated by continuous subcutaneous insulin infusion

Abstract

Aim: pregnancy in type 1 diabetes (T1D) is still associated with an increased risk of complications despite improved medical care. The aim of this study was to evaluate the effect of pregnancy planning on fetal and maternal outcomes in T1D women treated by continuous subcutaneous insulin infusion (CSII) before pregnancy. Methods: we retrospectively assessed pregnancy outcomes in T1D women treated by CSII before pregnancy who were followed in the Department of Diabetes in University Hospitals of Montpellier (France) or Padova (Italy) and gave birth between 2002 and 2017. We analyzed the medical records of 99 women. Results: 73 (73.7%) pregnancies had been planned. HbA1c levels were significantly lower before and during the whole pregnancy when it was planned (all p<0.01). Pregnancy planning reduced the age-adjusted risk of preterm birth (RR= 0.69 [0.50; 0.98] p<0.05). The risk reduction remained after adjustments for mother’s age above 40 years, high blood pressure or preeclampsia which were identified as confounding factors. Higher HbA1c levels in the first, the second and the third trimester were significantly associated with preterm birth (respective RR= 2.5 [1.13; 5.6], RR = 3.63 [1.30; 10.1] and RR= 3.96 [1.61; 9.756]; all p<0.05). Premature newborns were significantly more often admitted in intensive care unit than those born at healthy term (40% vs 13.2% p<0.05). Conclusions: pregnancy planning in T1D women treated by CSII was associated with improved glycemic control during pregnancy and a significant reduction in premature delivery. Hence, it looks valuable to encourage the planning through education programs of T1D pregnancies even in women using CSII. Remaining impaired outcomes in planned pregnancies could be minimized by new biomarkers of glucose control applied to the follow-up of diabetic pregnancies.
Objectif : le diabète de type 1 reste un facteur de risque de complications de la grossesse. L’objectif était d'évaluer l'effet de la programmation de la grossesse sur la survenue de complications obstétricales et néonatales chez les femmes diabétiques de type 1 traitée par CSII avant la grossesse. Méthode : nous avons étudié rétrospectivement le déroulement et l’issue des grossesses des femmes diabétiques de type 1 traitées par CSII avant la grossesse suivie par les départements de diabétologie des hôpitaux universitaires de Montpellier (France) et Padoue (Italie) et ayant accouché consécutivement entre 2002 et 2017. Les dossiers médicaux de 99 femmes ont été étudiés. Résultats : 73 grossesses (73,7%) étaient programmées. Les taux d'HbA1c étaient significativement plus bas avant et pendant toute la grossesse quand celle-ci était programmée (tous p <0,01). La programmation réduit le risque de prématurité (RR = 0,69 IC95 [0,5 ; 0,98] p <0,05). Ce résultat persistait après ajustement sur l'âge de la mère de plus de 40 ans, l’HTA gravidique ou la prééclampsie. L'augmentation de l’Hba1c au premier, deuxième et troisième trimestre était significativement associé au risque de prématurité (respectivement RR = 2,5 IC95 [1,13 ; 5,6], RR = 3,63 IC95 [1,30 ; 10,1] et RR = 3,96 IC95 [1,61 ; 9,756] p <0,05). Les nouveau-nés prématurés étaient significativement plus souvent admis en unité de soins intensifs (40% vs 13,2% p <0,05). Conclusion : la programmation de la grossesse chez les femmes traitées par CSII est associée à un meilleur contrôle glycémique pendant la grossesse et à une réduction significative du risque de prématurité.
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dumas-03019719 , version 1 (23-11-2020)

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Lucie Mourou. Effect of pregnancy planning on maternal and neonatal outcomes in type 1 diabetic women with type 1 diabetes treated by continuous subcutaneous insulin infusion. Médecine humaine et pathologie. 2018. ⟨dumas-03019719⟩
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