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Pregnancy Outcomes in Women with Type 1 Diabetes Treated with Long Acting Insulin Analogs. A Case Control Study

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dc.contributor.author Todorova – Ananieva, K.
dc.contributor.author Konova, E.
dc.contributor.author Guenova, M.
dc.date.accessioned 2013-09-26T09:22:38Z
dc.date.available 2013-09-26T09:22:38Z
dc.date.issued 2010-10
dc.identifier.citation K. Todorova – Ananieva, E. Konova, M. Guenova. Pregnancy Outcomes in Women with Type 1 Diabetes Treated with Long Acting Insulin Analogs. A Case Control Study - Acta Medica Bulgarica, 37, 2010, № 2, 21-31. en_US
dc.identifier.issn 0324-1750
dc.identifier.uri http://hdl.handle.net/10861/340
dc.description Address for correspondence: Katya Todorova – Ananieva MD, PhD High Risk Pregnancy Department Specialized Hospital of Obstetrics and Gynecology 2 Zdrave Str. 1431, Sofi a, Bulgaria **** tel. 00359 2851 7222 **** tel.00359 2851 7222 **** e-mail: todorova_kate@abv.bg en_US
dc.description.abstract The aim was to evaluate and compare the pregnancy outcome in women with type1 diabetes (T1D) intensively treated with long acting insulin or insulin analogs. A prospective two-year case control study in ninety pregnant women with T1D was performed. The intensifi ed treatment consisted of insulin aspart as bolus insulin and long acting insulin as basal. Women were divided into three groups according to the basal insulin: n1=30 treated with NPH insulin, n2=30 treated with insulin detemir and n3=30 treated with insulin glargine. Participants were matched for age, duration of diabetes, BMI, HbA1c before pregnancy parity, number of previous pregnancies and abortions. Metabolic control, diabetic complications, severe hypoglycemic episodes and pregnancy induced hypertension and preeclampsia were registered. Perinatal mortality, stillbirth, macrosomia, weeks and route of delivery and neonatal complications were also recorded. Statistical methods: ANOVA – with multiple comparison and chi square test have been used. No statistically signifi cant difference in mean values for age, diabetes duration, BMI, parity, and number of previous pregnancies. No differences were observed in pre-prandial, postprandial glucose and HbA1c levels in early pregnancy (HbA1c n1 = 7.3 ± 0.8%, n2 = 6.9 ± 0.9%, n3 = 7.1 ± 0.8%, P = 0.7). No differences were observed in postprandial glucose and Hba1c in late pregnancy (HbA1c n1 = 7.8 ± 0.3%, n2 = 7.3 ± 0.6%, n3 = 7.7 ± 0.7%, P = 0.06) as well. The level of preprandial glucose in late pregnancy was lowest in fi rst group (n1 = 4.5 ± 1.4 mmol/l, n2 = 6.6 ± 1.1 mmol/l, n3 = 6.9 ± 0.8 mmol/l, P = 0.0001). The doses of short acting insulin were signifi cantly higher in the fi rst group in early (n1 = 25.9 ± 34.5 U/kg, n2 = 17.0 ± 25.3 U/kg, n3 = 19.6 ± 26.7%, P = 0.004) and in late pregnancy (n1 = 41.1 ± 20.0 U/kg n2 = 26.1 ± 12.9 U/kg, n3 = 21.9 ± 10.1 U/kg, P = 0.0001). There were no differences in the dose of long acting insulin in early pregnancy between the groups, but in late pregnancy the dose in n1 group was statistically lower in comparison to the other two groups (n1 = 16.0 ± 6.8 U/kg n2 = 21.4 ± 8.2 U/kg, n3 = 29.7 ± 6.6 U/kg, P = 0.001). Severe hypoglycemic episodes in the fi rst group were observed at rate 16% (P = 0.03). There were no differences in frequency of hypoglycemic episodes between groups n2 and n3. Caesarean section was the main choice in all groups. There was statistically signifi cant difference in the time of delivery in the third group compared to the other groups (n1 = 36.7±1.1 week n2 = 36.2 ± 1.2 week, n3 = 37.5 ± 0.7 week, P = 0.001). The newborn’s body weight in third group was statistically higher than in the other two groups (n3 =3623.9 ± 527.8 g, n1 = 3364.3 ± 662.4 g, n2 = 3076.7 ± 798.7 g, P = 0.02). The incidence of Respiratory Distress Syndrome was higher in the fi rst group (P = 0.04). The frequency of neonatal hypoglycemia was higher in the third group (P = 0.003). The frequency of spontaneous abortion and stillbirths was higher in the third group, but without statistical signifi cance. The evaluations of risk factors could not establish relationship between the observed fetal complications and the insulin treatment. It is concluded that the treatment with long acting insulin analogs during pregnancy shows similar maternal effi cacy and safety. In terms of fetal complications and safety, the conduct of longer treatment trials in larger groups is needed. en_US
dc.language.iso en en_US
dc.publisher Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia en_US
dc.subject low-impact insulin analogues, diabetes mellitus type 1, pregnancy en_US
dc.title Pregnancy Outcomes in Women with Type 1 Diabetes Treated with Long Acting Insulin Analogs. A Case Control Study en_US
dc.type Article en_US

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  • Acta Medica Bulgarica
    Многопрофилно списание, излизащо само на английски език. Съдържа авторски статии от водещи български медицински специалисти, отразяващи върховите постижения на българската медицина наука и практика. Публикуват се материали, отразяващи резултати от експериментални проучвания, клиника и казуистика. Излиза 2 пъти годишно. ISSN:0324-1750

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