Study on pregnancy outcomes in patients with prepubertal onset of type I diabetes mellitus

Tashmanova Akmaral

2017

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DOI 10.26226/morressier.59d5184cd462b80296ca3f4f
Data confidence 70 medium
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Abstract

Agenda: to study characteristics of pregnancy in patients with prepubertal onset of type I diabetes mellitus (DM1). Materials and Methods: The subject of the study was 27 primiparous women, the average age of the patients at the time of pregnancy was 24.3 u00b1 4.9 years, the average age of debut of the disease was 9.9 u00b1 3.9 years, the average duration of diabetes was 11.2 u00b1 3.4 years. All patients received recombinant analogues of human insulin (Detemir and Aspart) in multiple injections regimen (basal-bolus). Evaluation of carbohydrate metabolism included: self-monitoring of glycemia (SMPG), fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) before pregnancy, during pregnancy and after childbirth.Studyresults: Analysis of microvascular complications showed that 48% (13) of patients had diabetic nonproliferative retinopathy, 41% (11) had diabetic nephropathy of varying severity, 4 patients (15%) had IV-V stage of chronic kidney disease.All patients reported not severe hypoglycemia during the first trimester of pregnancy, while 3 patients (11.1%) had severe hypoglycemia. The average daily need for insulin changed with the course of pregnancy. In the first trimester the average daily dose was 46.7 u00b1 11.0 U, in the second trimester - 51.6 u00b1 15.6 U, after birth - 48.6 u00b1 9.7 U. The mean HbA1c before pregnancy was 8.1 u00b1 1.1%, the mean HbA1c during pregnancy was 6.81 u00b1 1.5% and after childbirth at 3 months, 8.8 u00b1 1.6%. The following pregnancy outcomes were observed: the pregnancy was interrupted in 3 patients due to medical indication (early toxicosis, persistent vomiting of pregnant women, progression of diabetic nephropathy). In 17 patients (63%), the delivery was by caesarean section, with 11 cases at 34-36 weeks of gestation and 6 cases at 38-39 weeks. Only 7 (26%) of the patients had a natural birth in a period of 38-39 weeks. No cases of fetal death have been reported.Conclusions:Women with pregestational DM1 have high level microvascular complications (50%).During period of pregravid preparation, glycaemic control is not at target goal (HBA1c - 8.1 u00b1 1.1%), because women with diabetes do not inform the physician about pregnancy planning.Insulin Detemir and Aspart in indication basis-bolus regimen during pregnancy is effective and does not have a negative effect on pregnancy outcomes.