SAT-612 Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections For Glycemic Control In Pregnant Patients With Type 1 Diabetes: A Systematic Review And Meta-analysis

Abstract Disclosure: A.C. Alonso Ramírez: None. J.V. Salazar Ore: None. O. Murga: None. S.C. Salvatierra Moreno: None. H. Lana Devita: None. M. Nieto: None. L. Aly: None. J. John: None. G.D. Briceno Silva: None. S.Z. Saji: None. V.S. Arruarana: None. R. Correa Marquez: None. C. Sanchez Cruz: None. E. Calderon Martinez: None. C. Sierra: None. Introduction: Diabetes Mellitus (DM) is one of the most prevalent global health concerns, affecting approximately 537 million people worldwide and contributing to 1.5 million deaths annually. Pregnant women with pregestational type 1 DM (T1DM) face challenges in managing hyperglycemia, which increases the risk of adverse maternal and fetal outcomes. This meta-analysis aims to compare glycemic control between continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in pregnant women and asses their impact on maternal and neonatal outcomes. Methods: A systematic review (SR) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and preregistered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42025643129). Searches were performed on PubMed MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, CINDAHL, CNKI for studies comparing CSII and MDI in pregnant women. Outcomes included glycemic control, maternal complications, and neonatal outcomes. Statistical analysis was performed using R version 3.4.3 (R Core Team). Results: Thirty-one studies (n = 6,532) were included. CSII was associated with significantly lower HbA1c levels in the first trimester (MD: -0.35; 95% CI: -0.49 to -0.18; p < 0.01; I2 = 90.4%) and second trimester (MD: -0.15; 95% CI: -0.29 to -0.01; p = 0.04; I2 = 93.5%), but not in the third trimester. CSII users also required a lower daily insulin dose in the first trimester (SMD: -0.43; 95% CI: -0.61 to -0.24; p < 0.01; I2 = 64.4%). However, CSII was associated with an increased risk of cesarean delivery (RR: 1.11; 95% CI: 1.04 to 1.18; p < 0.01, I2=39.0%), neonatal hypoglycemia (RR: 1.15; 95% CI: 1.03 to 1.30; p = 0.02, I2=16.2%), and large for gestational age infants (RR: 1.22; 95% CI: 1.11 to 1.34; p < 0.01, I2=30.3%). No significant differences were observed in preeclampsia, preterm birth, congenital malformations, or small for gestational age outcomes. Conclusion: CSII provides improved glycemic control and reduced insulin requirements during early pregnancy compared to MDI. However, these metabolic benefits do not necessarily translate into better maternal or neonatal outcomes. Further high-quality randomized trials are needed to determine the optimal insulin therapy strategy in pregnant women with T1DM. Presentation: Saturday, July 12, 2025