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Evidence summaries

Continuous Subcutaneous Insulin Infusion for Pregnant Women with Diabetes

Continuous subcutaneous insulin infusion may probably not be superior to multiple daily injections for pregnant women with diabetes. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 5 studies with a total of 153 subjects. There was no significant difference in either of the primary outcomes; macrosomia (birthweight greater than 4000 g) (RR 3.20, 95% CI 0.14 to 72.62; 2 trials, n=61) and operative birth, caesarean birth being the only outcome reported (RR 1.09, 95% CI 0.66 to 1.77; 3 trials, n=71). No significant differences were found in any other outcomes measured, which may reflect the small number of trials suitable for meta-analysis and the small number of participants in the included studies. No significant differences were found in perinatal mortality (RR 2.33, 95% CI, 0.38 to 14.32; 3 trials, n=71), fetal anomaly (RR 1.07, 95% CI 0.07 to 15.54; 2 trials n=61), maternal hypoglycaemia (RR 3.00, 95% CI 0.35 to 25.87; 2 trials, n=61) or maternal hyperglycaemia (RR 7.00, 95% CI 0.39 to 125.4; 2 trials, n=61), or small-for-gestational age (average RR 1.40, 95% CI 0.10 to 18.71; 2 trials, n=61) .

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals).

    References

    • Farrar D, Tuffnell DJ, West J. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database Syst Rev 2007 Jul 18;(3):CD005542 [Assessed as up-to-date: 31 March 2016]. [PubMed]

Primary/Secondary Keywords