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Using continuous subcutaneous insulin infusion, as opposed to multiple daily injections for pregestational diabetes during pregnancy is linked with greater odds of cesarean delivery and the delivery of a large-for-gestational-age neonate.
According to a systematic review and meta-analysis, the application of continuous subcutaneous insulin infusion (CSII) as opposed to multiple daily injections (MDI) during pregnancies in women with pregestational diabetes mellitus is linked to an increased likelihood of cesarean delivery and the delivery of a large-for-gestational-age (LGA) neonate. The researchers sought to assess the clinical outcomes linked to the use of CSII compared to MDIs in pregnant females with pregestational diabetes mellitus.
A librarian-guided, systematic, predefined search was conducted across various medical databases, including ClinicalTrials.gov, Scopus, the World Health Organization International Clinical Trial Registry Platform, Cochrane Library, Embase, and MEDLINE (PubMed). This search resulted in the identification of 3003 studies that investigated the relationship between pregnancy outcomes and the use of CSII and/or MDI in women battling pregestational diabetes mellitus.
These studies primarily centered around the method of insulin delivery, with cesarean delivery as the main maternal outcome and neonatal hypoglycemia as the primary neonatal outcome. Additionally, the researchers assessed secondary outcomes such as hypertensive disorders during pregnancy, glycemic control in the first and third trimesters, the occurrence of LGA neonates, preterm birth, admission to the neonatal intensive care unit, the need for respiratory support, hyperbilirubinemia, 5-minute Apgar scores below 7, shoulder dystocia, and perinatal mortality.
To assess the data, random-effects models were utilized to compute pooled odds ratios (OR) alongside 95% confidence intervals. Among the 39 eligible studies, 39% of the 5518 pregnancies investigated incorporated the utilization of CSII. It was observed that the odds of cesarean delivery were greater among those utilizing CSII (as indicated by 20 studies: 63% with CSII vs. 56% with other methods), with an OR of 1.3. However, there was no significant difference detected in the odds of neonatal hypoglycemia (as demonstrated by 23 studies: 31% with CSII vs. 34% with other methods), with an OR of 1.1.
Among the secondary outcomes analyzed, only the odds of having an LGA neonate were found to be higher in individuals using CSII compared to those employing MDI (as evidenced by 20 studies: 47% with CSII vs. 38% with MDI), with an OR of 1.4. The utilization of CSII instead of MDI in pregnancies involving pregestational diabetes mellitus is linked to an increased likelihood of cesarean delivery and the birth of a neonate with LGA. Additional investigation is needed to better understand the impact of CSII on neonatal size and the choice of delivery method.
Journal of Diabetes Science and Technology
Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis
Stephanie A. Fisher et al.
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