Implications of Decreasing Insulin Requirements for Diabetes in Pregnancy: A Systematic Review [15D

Abstract

INTRODUCTION: Increased insulin resistance is a known physiologic change of pregnancy. For patients with gestational or preexisting diabetes being treated with insulin therapy, insulin requirements are expected to steadily increase throughout pregnancy. In a small subset of patients, insulin requirements decrease in the third trimester. It is felt by some practitioners that this clinical change is indicative of placental insufficiency, although current evidence is limited and conflicting. METHODS: A search strategy was developed to identify studies that compared maternal and neonatal outcomes in women with insulin-dependent diabetes who experienced a decrease in insulin requirement against those with insulin requirements that did not decrease in the third trimester. A systematic review was then carried out using MEDLINE, EMBASE, Cochrane Library, EBSCOHost CINAHL, Scopus, WOS Core Citation Indexes, Biosis Citation Index and Proquest Dissertations & Thesis Global databases. RESULTS: 1514 studies were identified using the search strategy, and 21 were selected for full-text review. Data extraction from these studies is ongoing. CONCLUSION: There are currently no guidelines to inform management of insulin-dependent diabetes in pregnancy when insulin requirements drop. However, this clinical scenario is often considered to be an indication for increased surveillance and/or delivery. This review will help clarify whether the additional surveillance of such patients is warranted, and may aid in the development of future guidelines regarding the management of such patients.