Key result
Falling insulin requirements of ≥15% in late pregnancy among women with preexisting diabetes were associated with an increased risk of placental dysfunction markers (OR 4.4; 95% CI 1.73-11.26; P=0.002).
Why the study?
Are falling insulin requirements associated with adverse obstetric outcomes in pregnant women with preexisting diabetes?
Cohort (n=139)
Are falling insulin requirements associated with adverse obstetric outcomes in pregnant women with preexisting diabetes?
Odds Ratio: 4.4 (95% CI 1.73–11.26)
p-value: p=0.002
In pregnant women with preexisting diabetes, a fall in insulin requirements of 15% or more in late pregnancy is a clinical marker for increased risk of placental dysfunction and adverse obstetric outcomes.
May warrant closer placental surveillance in late pregnancy; leaves open whether targeted interventions improve outcomes.
OBJECTIVE: To investigate the clinical significance of falling insulin requirements in women with preexisting or overt diabetes in pregnancy. RESEARCH DESIGN AND METHODS: A retrospective review of 139 pregnancies was conducted in women, with preexisting diabetes, delivering between January 2010 and January 2013. Women with falling insulin requirements of 15% or more from the peak total daily dose in late pregnancy were considered case subjects (n = 35). The primary outcome consisted of a composite of clinical markers of placental dysfunction, including preeclampsia, small for gestational age (SGA, ≤5th percentile for gestational age), stillbirth (>20 weeks), and premature delivery (≤30 weeks). RESULTS: A total of 25.2% of women had >15% fall in insulin requirements with nulliparity as the only predictor at baseline (odds ratio [OR] 2.5 [95% CI 1.1-5.7], P = 0.03). Falling insulin requirements were associated with an increased risk of preeclampsia (OR 3.5 [1.1-10.7], P < 0.05) and the composite of clinical markers of placental dysfunction (4.4 [1.73-11.26], P = 0.002). Although falling insulin requirements were associated with higher rates of SGA (3.4 [1.0-11.3], P = 0.048), they were not associated with other adverse neonatal outcomes. However, there was a higher incidence of neonatal intensive care unit admission (15.5 [3.1-77.6], P = 0.001) and earlier delivery in this group (median 37.7 weeks [IQR 34.3-38.4] vs. 38.3 weeks [37.4-38.9], P = 0.014). CONCLUSIONS: Falling insulin requirements, in women with preexisting diabetes, are associated with an increased risk of complications related to placental dysfunction. Further prospective studies are needed to guide clinical management.
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Padmanabhan et al. (2014) conducted a cohort in Preexisting or overt diabetes in pregnancy (n=139). Falling insulin requirements (≥15% from peak total daily dose in late pregnancy) vs. No falling insulin requirements was evaluated on Composite of clinical markers of placental dysfunction (preeclampsia, small for gestational age, stillbirth, and premature delivery) (OR 4.4, 95% CI 1.73-11.26, p=0.002). Falling insulin requirements of ≥15% in late pregnancy among women with preexisting diabetes were associated with an increased risk of placental dysfunction markers (OR 4.4; 95% CI 1.73-11.26; P=0.002).
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