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Am J Perinatol 2021; 38(06): 535-543
DOI: 10.1055/s-0040-1718579
SMFM Fellowship Series Article

Insulin Dosing, Glycemic Control, and Perinatal Outcomes in Pregnancies Complicated by Type-2 Diabetes

Hugh C.G. Nadeau 
1   Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
,
Marta E. Maxted
1   Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
,
Devika Madhavan
2   Department of Medicine, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
,
Stephanie L. Pierce
1   Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
,
Maisa Feghali
3   Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Christina Scifres
4   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations Funding M.F. is supported by the National Institutes of Health through grant number K23 HD092893. The funding source had no involvement in the preparation, analysis, and interpretation of the data or submission of this report.
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Abstract

Objective This study aimed to evaluate the prevalence of severe insulin resistance (insulin requirements ≥2 units/kg) at delivery and the relationship between severe insulin resistance, glycemic control, and adverse perinatal outcomes in pregnant women with type-2 diabetes mellitus.

Study Design This is a retrospective cohort study of women with type-2 diabetes mellitus who delivered between January 2015 and December 2017 at a tertiary academic medical center. Maternal demographic information, self-monitored blood sugars, and insulin doses were abstracted from the medical record. Multivariable logistic regression was used to identify maternal baseline characteristics associated with severe insulin resistance at delivery.

Results Overall 72/160 (45%) of women had severe insulin resistance. Women in the severe insulin resistance group demonstrated evidence of suboptimal glycemic control as evidenced by higher mean hemoglobin A1c (HbA1c) values (7.2 [ ±  1.1] vs. 6.6 [ ±  1.3%], p = 0.003), higher mean fasting (104.0 [ ±  17.4] vs. 95.2 [ ±  11.7 mg/dL], p < 0.001) and postprandial glucose values (132.4 [ ±  17.2] vs. 121.9 [ ± 16.9 mg/dL]), p < 0.001), and a higher percentage of total glucose values that were elevated above targets (37.7 [95% confidence interval (CI): 26.8–50] vs. 25.6 [95% CI: 13.3–41.3%], p < 0.001). Maternal HbA1c ≥6.5% and insulin use prior to pregnancy were associated with a higher prevalence of severe insulin resistance, while Hispanic ethnicity and non-White race were associated with a lower prevalence of severe insulin resistance. The rates of adverse perinatal outcomes including large for gestational age (LGA) birth weight, cesarean delivery, and hypertensive disorders of pregnancy did not differ between groups.

Conclusion Severe insulin resistance is common among pregnant women with type-2 diabetes, and it is associated with suboptimal glycemic control. Future studies are necessary to develop strategies to identify women with severe insulin resistance early in pregnancy and facilitate adequate insulin dosing.

Key Points

  • Severe insulin resistance is common.

  • BMI does not predict severe insulin resistance.

  • Suboptimal glycemic control is common.

Keywords

type-2 diabetes - insulin - severe insulin resistance

Authors' Contributions

H.C.G.N.: investigation, data curation, and writing the original draft; M.M.M.: investigation, writing, review, and editing; D.M.: investigation, writing, review, and editing; S.L.P.: writing, review, and editing; M.F.: conceptualization, writing, review, and editing; C.S.: conceptualization, methodology, formal analysis, investigation, and writing the original draft.


Note

Data from the were presented in part at the American Diabetes Association 79th Scientific Sessions, June 7–11, 2019, San Francisco, CA.




Publication History

Received: 03 April 2020

Accepted: 07 September 2020

Article published online:
16 October 2020

© 2020. Thieme. All rights reserved.

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