(HealthDay News) — For pregnant women with pre-existing diabetes, falling insulin requirement (FIR) is associated with altered expression of placental antiangiogenic factors and preeclampsia, according to a study published online in Diabetes Care.

Suja Padmanabhan, MBBS, MPH, from Westmead Hospital in Sydney, and colleagues conducted a multicenter cohort study involving 158 pregnant women with pre-existing diabetes (41 with type 1 and 117 with type 2). Thirty-two women had FIR of ≥15% from the peak total daily dose after 20 weeks of gestation and were considered case subjects. The primary outcome was a composite of clinical markers of placental dysfunction.

The researchers found that FIR ≥15% correlated with an increased risk of the composite primary outcome (odds ratio, 4.38) and preeclampsia (odds ratio, 6.76), and was more common among women with type 1 diabetes (36.6% vs 14.5%). Women with FIR ≥15% had modestly elevated creatinine; no difference was seen in hemoglobin A1c. Among women with FIR at 25, 30, and 36 weeks, the ratio of soluble fms-like tyrosine kinase 1 to placental growth factor was significantly higher, with differences maintained among those who developed preeclampsia. No difference was seen in placental hormones between the groups.

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“FIR is an important clinical sign, among women with pre-existing diabetes, that should alert the clinician to investigate underlying placental dysfunction,” the authors write.

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  1. Padmanabhan S, Lee VW, Mclean M, et al. The Association of Falling Insulin Requirements With Maternal Biomarkers and Placental Dysfunction: A Prospective Study of Women With Pre-existing Diabetes in Pregnancy. Diabetes Care. 10 August 2017. doi: 10.2337/dc17-0391