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Falling insulin requirement in late pregnancy: association with obstetric and neonatal outcomes

Journal of Perinatology volume 41, pages 1043–1049 (2021)Cite this article

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Abstract

Objective

To investigate whether diminishing insulin requirement in the third trimester is associated with placental dysfunction.

Study design

Two-year retrospective cohort study at one tertiary care center of women with pregestational or gestational diabetes, their insulin requirements, and complications associated with placental dysfunction.

Results

Of 157 women, 21 (13%) experienced declining insulin requirement, with average decline of 28% at 34 weeks. They were more likely to have pregestational diabetes (71.4% vs. 42.6%; p < 0.01) and delivered earlier (median 36w4d vs. 37w4d; p < 0.01). There was no difference in placental dysfunction related complications (33% vs. 24%; p = 0.37). There was an increased rate of polyhydramnios (42.9% vs. 8.8%; p < 0.01). NICU admission (62% vs. 33%; p < 0.01) and neonatal respiratory distress (52% vs. 24%; p < 0.01) was higher in cases of declining insulin requirement independent of gestational age.

Conclusions

A decline in insulin requirement should raise concern for increased risk of NICU admission and neonatal respiratory distress.

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Fig. 1: Neonatal ICU admission rate by gestational age, stratified by maternal insulin requirement status.
Fig. 2: Neonatal respiratory distress rate at birth by gestational age, stratified by maternal insulin requirement status.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA

    Barbara Wilkinson, Sarah Lassey & Sarah Little

  2. Department of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA

    Marie McDonnell & Nadine Palermo

Authors
  1. Barbara Wilkinson
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  2. Marie McDonnell
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  3. Nadine Palermo
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  4. Sarah Lassey
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  5. Sarah Little
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All authors contributed to study design and to manuscript review. BW completed data analysis and manuscript drafting, and SL completed statistical analysis.

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Correspondence to Barbara Wilkinson.

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Wilkinson, B., McDonnell, M., Palermo, N. et al. Falling insulin requirement in late pregnancy: association with obstetric and neonatal outcomes. J Perinatol 41, 1043–1049 (2021). https://doi.org/10.1038/s41372-021-00979-x

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