Parity increases insulin requirements in pregnant women with type 1 diabetes.

Parity increases insulin requirements in pregnant women with type 1 diabetes.

J Clin Endocrinol Metab. 2018 Mar 22;:

Authors: Skajaa GO, Fuglsang J, Kampmann U, Ovesen PG

Abstract
Context: Tight glycemic control throughout type 1 diabetes pregnancies is crucial and knowledge about which factors that affect insulin sensitivity could improve the outcome for both mother and offspring.
Objective: The purpose of the study was to evaluate insulin requirements in women with type 1 diabetes during pregnancy and test whether parity affects insulin requirements.
Design: We conducted an observational cohort study consisting of women with type 1 diabetes who gave birth at Aarhus University Hospital, Denmark from 2004-2014.
Main Outcome Measure: Daily insulin requirement. The hypothesis that parity could affect insulin resistance was formulated before data collection.
Results: 380 women with a total of 536 pregnancies were included in the study. Mean age was 31.1y and prepregnancy HbA1c 60 mmol/mol. Parity was: P0=43%, P1=40%, P2=14% and P3+4=3%. Insulin requirements from week 11-16 decreased significantly with 4% (p=0.0004) and rose from week 19 to delivery with a peak of 70% (p<0.0005) at week 33-36. Overall, insulin requirements increased significantly with parity. The unadjusted differences between P0 and P1, P2 and P3+4 were 9 (p<0.0005), 12 (p<0.0005) and 23% (p<0.0011), respectively. After adjusting for confounders differences were 13 (p<0.0005), 20 (p<0.0005) and 36% (p<0.0005). We also observed an adjusted difference between P1 and P3+4 at 20% (p<0.0012).
Conclusions: Our data show changes in insulin requirements from week to week in pregnancy and indicate that insulin requirements increase with parity. This suggests that the patient's parity probably should be considered when deciding insulin dosages for pregnant women with type 1 diabetes.

PMID: 29584894 [PubMed - as supplied by publisher]

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