Continuous subcutaneous infusion of insulin (CSII) during pregnancy and fetal size

The outcome of eight pregnancies in diabetic patients managed with continuous subcutaneous infusion of insulin (CSII) during the latter two trimesters of pregnancy was compared with that of twelve pregnancies managed with conventional insulin therapy (CIT). CSII‐controlled women had fasting mean blood glucose concentrations ranging between 3.8–5.8 mmol/l and HbA1 between 6.6–8.2% (upper limit of normal: 8.5%). Conventionally treated patients had HbA1 levels ranging between 7.2–10.5%. The mean gestational age at delivery was 38.8 weeks in the CSII group and 38 weeks in the CIT group; the caesarian section rate in the two groups was 3/8 and 3/12. Three babies in the CSII group were macrosomic with a birth weight at 90th centile or greater, whereas one was macrosomic in the CIT group. The incidence of neonatal hypoglycaemia, hypocalcaemia and respiratory distress was similar in both groups. We conclude that the use of CSII and the institution of near‐perfect diabetic control during the latter two trimesters of pregnancy does not significantly alter the outcome of pregnancy, when compared with pregnancies reasonably well‐controlled with CIT. Prevention of macrosomia and other complications of the diabetic pregnancy must be attempted by instituting near‐perfect control of diabetes prior to conception and throughout pregnancy.