Aim To examine pregnancy outcome in women with Type 1 diabetes treated with glargine.
Methods Glargine use in pregnancy was surveyed over 2 years in 20 UK obstetric-diabetes centres. Outcomes, including maternal complications, miscarriage, congenital abnormalities, perinatal morbidity and mortality, were recorded in a standardized format.
Results Outcomes on 109 babies from 115 women with Type 1 diabetes were collected. Insulin glargine was used prior to pregnancy in 69% of women, started during pregnancy in 30%, and stopped at booking in one patient. Insulin aspart was the bolus insulin in 45%, lispro in 42% and human soluble in 8% of women. HbA1c fell from 8.1 ± 0.2% at booking to 6.8 ± 0.1% during the third trimester. Background retinopathy developed in one patient, worsened in seven and laser photocoagulation was required in three women. Preeclampsia occurred in 12%, and 14% of women had more than one episode of severe hypoglycaemia. One hundred and nine babies were live born, with six miscarriages and no neonatal deaths. The mean gestational age was 37.5 weeks, and mean birth weight was 3500 g. Three babies had congenital abnormalities (malformation rate = 28/1000). Neonatal hypoglycaemia was seen in 46% and hyperbilirubinaemia in 22% of babies. No major adverse outcome was noted in a smaller subset of five Type 2 and seven gestational diabetes patients on glargine.
Conclusions The use of glargine in Type 1 diabetes during pregnancy was not associated with any unexpected adverse maternal or fetal outcome in this study.