(1159) Continuous subcutaneous infusion versus multiple daily injections of insulin for type 1 diabetes in pregnancy

Pregnant persons with type 1 diabetes (T1DM) increasingly use continuous subcutaneous insulin infusion (CSII) therapy, although data on outcomes have been mixed. This study aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDI) in pregnant persons with T1DM in a contemporary meta-analysis.

Study Design:

A predefined, systematic, librarian-assisted search of Ovid MEDLINE, Embase, Scopus, Cochrane, World Health Organization International Clinical Trial Registry Platform, and ClinicalTrials.gov (published from 2010-2022) yielded 2978 studies describing outcomes associated with CSII and/or MDI for T1DM in pregnancy. The primary exposure was mode of insulin delivery, with cesarean section and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included preeclampsia, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit (NICU) admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar < 7, shoulder dystocia, and perinatal mortality (intrauterine fetal demise or neonatal death). We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random effects models.

Results:

Of 30 studies with 5418 pregnancies meeting inclusion criteria, 39% of pregnancies were exposed to CSII. The odds of cesarean section were higher in individuals treated with CSII compared to those using MDI (20 studies: 63% vs. 56%, OR 1.3 [95% CI 1.2-1.5], Figure). No difference in neonatal hypoglycemia was detected (23 studies: 31% vs. 34%, OR 1.1 [95% CI 0.9-1.5]). The odds of delivery of an LGA neonate were greater among those treated with CSII versus MDI (20 studies: 47% vs. 38%, OR 1.4 [95% CI 1.2-1.6]), but no differences were detected in the other secondary outcomes assessed (Table).

Conclusion:

CSII use for pregnant individuals with T1DM is associated with higher odds of cesarean section and delivery of an LGA neonate compared to MDI. Further evaluation of how CSII use may alter fetal growth trajectory and neonatal size, and thereby influence route of delivery, is warranted.