Managing type I diabetes in pregnancy: how near normal is necessary?

Abstract

Objective: This was a feasibility study to determine if pregnant women with type I diabetes managed with liberal target glucose values will have a decreased frequency of hypoglycemia with no differences in adverse outcomes compared with tightly controlled subjects.

Study design: Twenty-two women who had type I diabetes were randomized in first trimester to 'rigid' and 'less rigid' groups. Participants recorded blood glucose results and symptoms of hypoglycemia on memory-based meters.

Results: Mean maternal glucose was significantly greater in first and second trimesters among patients in the 'less rigid' group. Both subjective and objective hypoglycemias were more frequent in the 'rigid' group. There were no differences between groups in cesarean deliveries, birth weights and neonatal glucose concentrations.

Conclusions: Utilizing glucose targets higher than those conventionally recommended in pregnancies of women who have type I diabetes may decrease maternal hypoglycemia while not increasing maternal or perinatal morbidity. The findings of this study justify further investigation with a larger patient base.