Treatment regimes in type 2 diabetic pregnancies: analysis of West Midlands confidential enquiry data. (16th November 2010)

• Record Type: Journal Article
• Authors: Shah, N; Brydon, P; Dyer, P; Gardosi, J
• Is Part Of: Archives of disease in childhood. Volume 95(2010)Supplement 1
• Page Start: Fa43
• Page End: Fa43
• Publication Date: 2010-11-16
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/adc.2010.189753.34
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Aim: To analyse glycaemic treatment regimes in type 2 diabetes and how these change throughout pregnancy within the West Midlands (WM) region, UK. Methods: Data from the WM Diabetes in Pregnancy project 2002–2003 (Confidential Enquiry) were collected on treatment regimes during pregnancy, including types of insulin/oral agents (OHAs) prescribed. Maternal ethnicity, demographic and pregnancy outcome data were correlated to treatment regimes. Results: 34 type 2 pregnancies were examined – 32% European, 50% South-Asian and 18% other non-European. Prepregnancy 47% of women were managed with OHAs and 18% with diet alone. Metformin was the most commonly prescribed OHA (74%). 24% used insulin alone prepregnancy. This was significantly associated with a poor pregnancy outcome (p<0.05). 80% of women changed onto a different treatment regime during pregnancy. 56% stopped their OHA and commenced insulin at a first hospital appointment (58% – first trimester). The majority of these were South-Asian/non-European (14/19 cases). 91% of women received insulin at some point in the pregnancy – half were treated with a basal-bolus regime and half with a mixed insulin twice daily regime. Postnatally 50% of women reverted back to their prepregnancy regime with half remaining on insulin. Conclusion: The method of glycaemic treatment before pregnancy was associated with poor outcomes. Those women requiring insulin may have poorer controlled/more severe disease. However neither treatment regimes per se during pregnancy nor maternal ethnicity influenced the pregnancy outcome. The workload associated with starting insulin during a pregnancy is considerable and requires multidisciplinary input.