Abstract | OBJECTIVE: To investigate whether pregnancies complicated by type 1 diabetes are associated with a decrease in first-trimester insulin requirement. RESEARCH DESIGN AND METHODS: We examined the weekly insulin requirement (as units per kilogram per day) during the first trimester of pregnancy in diabetic women in the Diabetes in Early Pregnancy Study ( DIEP) with accurate gestational dating, regular glucose monitoring, daily insulin-dose recording, and monthly glycohemoglobin measurements. RESULTS: In pregnancies that resulted in live-born full-term singleton infants, a significant 18% increase in mean weekly dosage was observed between weeks 3 and 7 (P = 0.000), followed by a significant 9% decline from week 7 through week 15 (P = 0.000). Further testing localized a significant change in insulin dose in the interval beginning weeks 7-8 and ending weeks 11-12 (P = 0.014). Within this interval, the maximum decrease was between weeks 9 and 10 (mean), 10 and 11 (median), and 8 and 9 (most frequent maximal decrease). To determine whether prior poor glucose control exaggerated these trends, we categorized the women based on their glycohemoglobin values: <2 SDs above the mean of a normal population (subgroup 1), 2-4 SDs (subgroup 2), and >4 SDs (subgroup 3) at baseline. Late first-trimester declines in dosage were statistically significant in subgroup 2 (P = 0.002) and subgroups 2 and 3 together (P = 0.003). Similarly, women with BMI >27.0 had a greater initial insulin rise and then fall compared with leaner women. CONCLUSIONS: Observations in the DIEP cohort disclose a mid-first-trimester decline in insulin requirement in type 1 diabetic pregnant women. Possible explanations include overinsulinization of previously poorly controlled diabetes, a transient decline in progesterone secretion during the late first-trimester luteo-placental shift in progesterone secretion, or other hormonal shifts. Clinicians should anticipate a clinically meaningful reduction in insulin requirement in the 5-week interval between weeks 7 and 12 of gestation.
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Authors | L Jovanovic, R H Knopp, Z Brown, M R Conley, E Park, J L Mills, B E Metzger, J H Aarons, L B Holmes, J L Simpson, National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study Group |
Journal | Diabetes care
(Diabetes Care)
Vol. 24
Issue 7
Pg. 1130-6
(Jul 2001)
ISSN: 0149-5992 [Print] United States |
PMID | 11423491
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Blood Glucose
- Glycated Hemoglobin A
- Insulin
- Thiobarbituric Acid Reactive Substances
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Topics |
- Adolescent
- Adult
- Age Factors
- Alcohol Drinking
- Blood Glucose
(metabolism)
- Cohort Studies
- Diabetes Mellitus, Type 1
(blood, drug therapy)
- Diabetic Retinopathy
(epidemiology)
- Dose-Response Relationship, Drug
- Educational Status
- Ethnicity
- Female
- Gestational Age
- Glycated Hemoglobin
(analysis)
- Humans
- Income
- Infant, Newborn
- Insulin
(therapeutic use)
- Pregnancy
- Pregnancy Trimester, First
- Pregnancy in Diabetics
(blood, drug therapy)
- Proteinuria
(epidemiology)
- Racial Groups
- Smoking
- Socioeconomic Factors
- Thiobarbituric Acid Reactive Substances
(analysis)
- United States
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