Grossesse et diabète de type 1: impact du schéma d'insulinothérapie intensive sur la croissance fœtale

This study was aiming to compare the rate of macrosomia and mean birth weight (percentile) in newborns of women with type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDII). It is a retrospective study including all singleton pregnancies complicated with T1D treated at CHU Sainte-Justine (Montreal, Quebec, Canada), who delivered at ≥ 16 weeks between January 1, 2000 and January 31, 2009. Fourteen pregnancies were treated with CSII and 94 with MDII. There were no significant differences between the two groups in HbA1c levels in the 1st, 2nd or 3rd trimester of pregnancy. The mean birth weight percentile (92±11 versus 77±26) and the rate of macrosomia (71.4% versus 42.6%, respectively) were significantly higher in the CSII group (p<0.05). Maternal weight gain was identified as a predictor of fetal macrosomia and the presence of a hypertensive disorder was associated with a lower rate of macrosomia. We conclude that continuous subcutaneous insulin infusion was associated with higher rate of macrosomia and higher birth weight despite similar diabetic control.