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[IP] Pump Therapy study pregnancy and Type 1

Am J Obstet Gynecol 2000 Jun;182(6):1283-1291 Related Articles, Books, 

Benefits, risks, costs, and patient satisfaction associated with insulin pump 
therapy for the pregnancy complicated by type 1 diabetes mellitus. 

Gabbe SG, Holing E, Temple P, Brown ZA 

Diabetes in Pregnancy Program, Departments of Obstetrics and Gynecology and 
Pediatrics, University of Washington Medical Center.

[Record supplied by publisher]

OBJECTIVE: Glycemic control, perinatal outcome, and health care costs were 
evaluated among women with type 1 diabetes mellitus who began insulin pump 
therapy during pregnancy (group 1, n = 24), were treated with multiple 
insulin injections (group 2, n = 24), or were already using an insulin pump 
before pregnancy (group 3, n = 12). Patient satisfaction and continuation of 
pump therapy post partum were assessed.Study Design: A retrospective review 
of maternal and neonatal medical records was performed, and a questionnaire 
was sent to patients after delivery. Patients in groups 1 and 2 were matched 
for age, age at onset and duration of diabetes mellitus, White class, and 
date of delivery. RESULTS: No differences in glycosylated hemoglobin A levels 
were observed among groups 1, 2 or 3 in the first, second, or third 
trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks' 
gestation, and 17 (70.8%) began therapy as outpatients. No deterioration in 
glycemic control was noted during the 2- to 4-week period after the start of 
pump treatment. Among the women in group 1 eight had at least one episode of 
severe hypoglycemia before starting pump therapy, but only one had such an 
episode after this treatment was begun. Two episodes of ketoacidosis occurred 
in group 1, and no episodes occurred in groups 2 and 3. No significant 
differences in perinatal outcomes or health care costs were observed among 
groups 1, 2, and 3. After delivery 94.7% of the women in group 1 continued to 
use the pump because it provided better glycemic control and a more flexible 
lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 
and 9.1% in group 2, a significant difference. CONCLUSIONS: Insulin pump 
therapy was initiated during pregnancy without a deterioration of glycemic 
control and was associated with maternal and perinatal outcomes and health 
care costs comparable to those among women who were already using the pump 
before pregnancy or who received multiple-dose insulin therapy. Women who 
began pump therapy in pregnancy were highly likely to continue pump use after 
delivery and preferred the flexible lifestyle that this treatment allowed.

PMID: 10871440  <A 
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