The real world effectiveness of diabetes technology in pregnant women with type 1 diabetes (T1D) is a matter of debate, but an optimal preconception HbA1c is considered a key factor for a successful pregnancy. Aim of this study is to assess the effectiveness of Insulin Pumps (IP) vs Multiple Daily Injection (MDI) and Continuous Glucose Monitoring (CGM) vs Blood Glucose Monitoring (BGM) in pregnant women with T1D.
We retrospectively compared fetal, neonatal and maternal complication rate (primary outcome) and preconception - 3rd trimester HbA1c difference (ΔHbA1c) (secondary outcome) between pregnancies managed with IP vs MDI (both with or without CGM) and with CGM vs BGM (both with or without IP).
From 2012 until to 2019 we managed 66 pregnancies in 53 women with T1D (mean age ± SD = 31.1 ± 6.1 years). We didn't find any significant difference in complication rate (pregnancies with complications/without complications) between IP vs MDI (27/26 vs 7/6, n.s.) nor between CGM vs BGM (13/7 vs 21/25, n.s.); ΔHbA1c was significantly higher with IP than MDI (1.43 ± 0.24 vs 0.72 ± 0.91%, p < 0.05) and similar with CGM vs BGM (1.23 ± 1.54 vs 1.29 ± 1.37 %, n.s.). Of note, preconception HbA1c was significantly higher with IP vs MDI (8.21 ± 1.91 vs 6.83 ± 1.11%, p < 0.05).
Despite significantly higher preconception HbA1c, pregnancies managed with IP resulted in a significant reduction of HbA1c and a comparable complication rate in comparison to those managed with MDI but with an optimal preconception HbA1c.