Aim To analyse glycaemic treatment regimes in type 2 diabetes and how these change throughout pregnancy within the West Midlands (WM) region, UK.
Methods Data from the WM Diabetes in Pregnancy project 2002–2003 (Confidential Enquiry) were collected on treatment regimes during pregnancy, including types of insulin/oral agents (OHAs) prescribed. Maternal ethnicity, demographic and pregnancy outcome data were correlated to treatment regimes.
Results 34 type 2 pregnancies were examined – 32% European, 50% South-Asian and 18% other non-European. Prepregnancy 47% of women were managed with OHAs and 18% with diet alone. Metformin was the most commonly prescribed OHA (74%). 24% used insulin alone prepregnancy. This was significantly associated with a poor pregnancy outcome (p<0.05). 80% of women changed onto a different treatment regime during pregnancy. 56% stopped their OHA and commenced insulin at a first hospital appointment (58% – first trimester). The majority of these were South-Asian/non-European (14/19 cases). 91% of women received insulin at some point in the pregnancy – half were treated with a basal-bolus regime and half with a mixed insulin twice daily regime. Postnatally 50% of women reverted back to their prepregnancy regime with half remaining on insulin.
Conclusion The method of glycaemic treatment before pregnancy was associated with poor outcomes. Those women requiring insulin may have poorer controlled/more severe disease. However neither treatment regimes per se during pregnancy nor maternal ethnicity influenced the pregnancy outcome. The workload associated with starting insulin during a pregnancy is considerable and requires multidisciplinary input.
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