Can structured education allow women to effectively self-manage csii during the intra-partum period

Abstract

Continuous subcutaneous insulin infusion (CSII) is an effective method of maintaining blood glucose targets for selected women during pregnancy. However a lack of professional knowledge regarding CSII may be a barrier to its use, especially during the complex and dynamic intra-partum stage. To enhance the birthing experience a specialist multidisciplinary antenatal clinic service developed guidelines and a structured education programme empowering women to self-manage their diabetes during the intra-partum period. Pregnant women attending the service underwent regular review and education which included self-management in the intra-partum period and individualised CSII birth plans. To date sixty-seven pregnancies have booked into the service (36 primigravidas, 66 Type 1 diabetes) with 58 deliveries (initial HbA1c 53.8 ±11.9 (36-89) mmol/mol (mean,SD(range)), age 30.75 ±5.09 (19-41) years, diabetes duration 14.4 ±8.12 (0-32) years. Prior to CSII all experienced frequent hypoglycaemic events. Thirty-three women converted onto CSII during pregnancy (range 5-25 weeks gestation). Complications included 26 retinopathy, 10 hypertension, 2 nephropathy and 3 gastroparesis. From this group, 58 women have delivered and self-managed CSII in the intra-partum period (gestation 35.5 ± 2.92 (23-38.4) weeks, birth weight 3877 ± 5496 (1050-3965)g). All women maintained self-testing blood glucose values below 9mmol/l. Forty-one needed caesarean section under spinal anaesthetic and 34 received corticosteroids due to prematurity risk. Thirtyfour infants were admitted to special care (20 prematurity, 12 hypoglycaemic). Pre-delivery HbA1c was 49 ± 8.67 (33-78) mmol/mol with no major hypoglycaemic episodes. Training eliminates professional anxieties and inexpert attempts to discontinue CSII too early are otherwise pre-empted. With support and education, women can be empowered to self-manage CSII and maintain appropriate glycaemic targets during the intra-partum period.