Important Role of Pregnancy Planning for Pregnancy Outcomes in Type 1 Diabetes

Background/Objectives: Pregnancy in women with type 1 diabetes (T1D), compared to general pregnant population, is still associated with an increased number of perinatal complications affecting both fetus and mother. The Great Orchestra of Christmas Charity Foundation (GOCCF) program enables use of continuous subcutaneous insulin infusion (CSII) enhanced by hypo-stop function with real-time continuous glucose monitoring (rtCGM) at the stage of procreation or early pregnancy in T1D patients. The aim of this observational study was to analyze association between pregnancy planning and pregnancy outcomes in patients qualified for the GOCCF program. Methods: 98 women with T1D, aged 21-41 years, initiating CSII + rtCGM system at the stage of planning/early pregnancy or later in case of unplanned pregnancy were qualified for the study. We analyzed glycemic control, insulin requirements, pregestational BMI, maternal weight gain, occurrence of preterm birth, congenital malformations and birthweight of newborns. Results: Women who planned pregnancy had significantly better glycemic control before and throughout entire pregnancy and significantly higher proportion of them achieved TIR >70% (58.7% vs. 28.9%, P=0.014) and TAR <25% (65.2% vs. 24.4%, P<0.001). Their glucose variability at the end of pregnancy was significantly lower, 29.4±5.5, vs. 31.9±5.1, P=0.030. They also gave birth later, after mean 37.8±0.9 vs. 36.9±1.8 weeks in non-planning group, P=0.039. Preterm birth occurred in 5 women (10,4%) who planned pregnancy and in 15 women (30%) with unplanned gestation, P=0.031. Conclusions: Planning pregnancy in T1D is associated with better glycemic control before conception and throughout entire pregnancy, which is translated into better pregnancy outcomes.