Abstract
The management of diabetes in pregnancy varies depending on whether the condition was first diagnosed during pregnancy (gestational diabetes) or was diagnosed before pregnancy (pregestational diabetes). Little has been published comparing the relative efficacy of various oral agents for the treatment of gestational diabetes and the reported experience with the insulin pump in pregnancy for pregestational diabetes remains meager. We conducted a retrospective chart review of women managed in a specialized diabetic clinic to compare the results of treatment of gestational diabetes with oral agents, glyburide and acarbose, to those treated with split-mixed insulin and treatment of pregestational diabetes with either the insulin pump or conventional splitmixed insulin. Gestational diabetics treated with split-mixed insulin were hospitalized significantly more often (p < 0.001) than those treated with oral agents only. The incidence of several important pregnancy complications (growth restriction, preterm labor, preeclampsia, oligohydramnios) did not differ between groups. Pregestational diabetics managed with an insulin pump had comparable glycemic control, as measured by hemoglobin A1c, to those managed with split-mixed insulin. Infant birth weights and Apgar scores were similar in each group. There were no perinatal deaths in either group. Acarbose and glyburide showed comparable efficacy in treating gestational diabetics. In addition, our experience adds to the small number of pregnant women with pregestational diabetes who were managed with an insulin pump that have been reported in the literature.
Highlights
Health care personnel in the United States today are struggling to contend with two interrelated epidemics: Obesity and diabetes [1] [2]
Staff, and department leadership has made it difficult to maintain a consistent approach to management of diabetes, and the obvious differences in the treatment of gestational and pregestational diabetes adds a layer of complexity
One team of investigators focused on women with gestational diabetes managed from 2005 to 2008, while a second team focused on pregestational diabetics cared for between 2006 and 2009
Summary
Health care personnel in the United States today are struggling to contend with two interrelated epidemics: Obesity and diabetes [1] [2]. Those who provide care for pregnant women are challenged by obesity and diabetes, but by the need to optimize pregnancy outcome for both women and their offspring. In response to this challenge, many institutions have established specialized antenatal clinics to provide care to pregnant diabetics, including women with gestational diabetes and those with pregestational diabetes.
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