Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes

Farrar D, Tuffnell DJ, West J

Summary

Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes

Insufficient evidence on different ways of administering insulin for pregnant women with diabetes.

Diabetes is a condition in which glucose (sugar) in the blood is too high because the body has either no insulin or not enough insulin. Insulin is a hormone produced by the pancreas; it enables glucose to enter the cells where it is used as fuel by the body. Controlling blood sugar levels is important in diabetes because too high or too low blood sugar can affect the brain and other organs of the body. It is also very important to control the blood sugar in pregnant women who have diabetes because poor blood sugar control increases the risk of abnormalities in the baby, increases the chance of miscarriage or stillbirth and can also lead to large babies (macrosomia) who may then have a difficult birth. Traditionally insulin injections are given as multiple daily injections (MDI) but an alternative way to give insulin is as a continuous infusion by a small pump via a fine tube placed under the skin (CSII). It has been suggested that CSII may result in a more stable blood glucose, and so a lower chance of too high or too low blood sugar level happening, which may benefit the baby as well as the mother; there may be adverse effects too. This review of trials looked at CSII compared with MDI for administering insulin to pregnant women with diabetes. Two trials involving 60 women with 61 pregnancies were identified. This provided insufficient data to be able to say which method of insulin administration was better. Further research is needed.