Women with diabetes are at higher risk for a number of Complications if they become pregnant, including premature birth, low or high birth weight, stillbirth, and congenital abnormalities.
Existing evidence has shown that lifestyle interventions can help reduce complications and improve outcomes in patients with diabetes. However, it is less known whether the complications associated with pregnancy can be reversed. The problem is particularly problematic in relation to type 2 diabetes (T2D), which is a growing problem in many parts of the world.
Helen R. Murphy, MD of the University of East Anglia and colleagues recently graduated 5-year population-based cohort study of more than 15,000 pregnancies in the UK, Wales and Isle of Man completed between 2014 and 2018 and included in the UK’s National Pregnancy in Diabetes database.
HCPLive asked Murphy to discuss what they found and what they say about the benefits of intervention.
HCPLive: Diabetes in Pregnancy has already been studied, but your study stands out for its size and scope. Half of the pregnancies were in women with type 1 diabetes (T1D) and half were in women with type 2 diabetes. What does such a large study population mean?
Murphy: Yes, this is by far the largest current study on pregnancy for diabetes. In the past there have been some studies of 5,000 pregnancies in women with type 1 diabetes, but usually over a period of more than 15 years (e.g. Sweden 1991-2003). At the time of their publication these are already out of date. Our data is contemporary and very relevant to current clinical practice. In particular, no previous study has included large numbers of women with type 2 diabetes, which is a growing problem in women of childbearing age, especially women from disadvantaged or black and ethnic minorities.
In your study, maternal glycemia and body mass index (BMI) were identified as important modifiable risk factors in pregnant women with diabetes. How should doctors advise women with diabetes planning to become pregnant?
Pre-pregnancy BMI in mothers had an important impact on glucose levels during pregnancy. So I think encouraging women to optimize their food intake and enter pregnancy with the healthy weight possible before pregnancy is a really important part of pregnancy planning in both T1 and T2D.
Should the focus be on pre-pregnancy interventions, or can significant changes be made during pregnancy?
During pregnancy, efforts can be made to limit excessive weight gain during pregnancy. However, it’s too late to reverse the effects of overweight / obese BMI on entering pregnancy.
Was there a particular finding that surprised you?
I was surprised at the effects of mother’s weight on T1D. We already knew maternal glycemia was important, but what I didn’t know was that early pregnancy BMI had such a strong impact on maternal glucose levels during pregnancy and thus on pregnancy outcomes.
At T2D, I expected an impact from maternal obesity, but was surprised at the impact of glucose in mothers – which was far greater than expected.
What are the key takeaways for clinicians?
The good news is that maternal glucose is relatively easy to modify in T2D pregnancy. So, for me, the takeaway news should focus a little more on the pre-pregnancy weight of the mother in T1D and the maternal glucose level during pregnancy in the T2D pregnancy.
The other key message is that changes are needed in all clinics to intensify glycemic management. In T1D this means the introduction of [continuous glucose management] For all pregnant women in all maternity hospitals and for T2D, we must seriously consider programs for diabetes prevention and pre-pregnancy weight management.
