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Falling Insulin Requirements Linked to Placental Dysfunction

TUESDAY, Aug. 12, 2014 (HealthDay News) -- For women with preexisting diabetes, falling insulin requirements correlate with increased risks of adverse outcomes associated with placental dysfunction, according to a study published online July 28 in Diabetes Care.

Suja Padmanabhan, M.B.B.S., from Westmead Hospital in Australia, and colleagues conducted a retrospective review to examine the clinical significance of falling insulin requirements in women with preexisting or overt diabetes in pregnancy. Data were collected from 139 pregnancies in women with preexisting diabetes. Case subjects were those with falling insulin requirements of 15 percent or more from the peak total daily dose in late pregnancy (35 women).

The researchers found that 25.2 percent of women had a >15 percent fall in insulin requirements, with nulliparity the sole predictor at baseline (odds ratio [OR], 2.5; P = 0.03). An elevated risk of preeclampsia (OR, 3.5) and the composite of clinical markers of placental dysfunction (OR, 4.4) were seen in association with falling insulin requirements. Falling insulin requirements correlated with higher rates of small for gestational age (OR, 3.4; P = 0.048), but not with other adverse neonatal outcomes. However, those with falling insulin requirements had a higher incidence of neonatal intensive care unit admission (OR, 15.5) and earlier delivery (median 37.7 versus 38.3 weeks; P = 0.014).

"Further prospective studies are needed to guide clinical management," the authors write.

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