Associations of insulin pump and continuous glucose monitoring use with pregnancy-related outcomes in women with type 1 diabetes

Abstract

Aims: To examine insulin pump and continuous glucose monitoring (CGM) use with pregnancy-related outcomes in women with type 1 diabetes.

Methods: We abstracted medical records of 646 pregnancies in 478 women with type 1 diabetes, with information on insulin pump versus multiple daily injection (MDI) use and CGM use. We analyzed the associations of pump vs. MDI use, CGM use vs. non-use and pregnancy-related outcomes using mixed effect models.

Results: Pump use was associated with lower HbA1c levels in the first [β (95% CI) = -0.33 (-0.51, -0.15) %] and second trimester [β (95% CI) = -0.13 (-0.24, -0.02) %], increased birth weight [β (95% CI) = 0.14 (0.02, 0.26) kg], birth weight percentile [β (95% CI) = 4.87 (0.49, 9.26) %], higher odds of large for gestational age [OR (95% CI) = 1.65 (1.06, 2.58)] and macrosomia [OR (95% CI) = 1.81 (1.03, 3.18)]. CGM use was associated with lower first [β (95% CI) = -0.38 (-0.64, -0.13) %] and third trimester [β (95% CI) = -0.17 (-0.33, -0.00) %] HbA1c levels.

Conclusions: Women with type 1 diabetes who used pump or CGM had better glycemic control during pregnancy; however, pump use was associated with higher birth weight measures.

Keywords: Continuous glucose monitoring; Diabetes; Insulin pump; Multiple daily injections; Pregnancy; Pregnancy outcomes; Type 1 diabetes.