Women with diabetes have a higher risk of several diseases complications if they are pregnant, including preterm 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 diabetes patients, but whether pregnancy-related complications can be reversed is poorly understood. The problem is very troublesome in terms of 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 completed a Population-based cohort study over 5 years more than 15,000 pregnancies in Great Britain, Wales and the Isle of Man completed between 2014-2018 and were included in the UK’s National Pregnancy Database for Diabetes.
HCPLive asked Murphy to discuss what his findings were and what they had to say about the benefits of the intervention.
HCPLive: Diabetes in pregnancy has been studied before, but your research is well known for its size and scope. Half of the pregnancies occur in women with type 1 diabetes (T1D) and half in women with type 2 diabetes. What are the implications of having such a large study population?
Murphy: Yes, by far the largest contemporary study in diabetes pregnancy. Historically, there have been several studies of 5,000 pregnancies in women with type 1 diabetes but usually over a time period of 15 years (eg Sweden 1991-2003), so at the time of publication this was outdated. Our data are contemporary and highly relevant to current clinical practice. In particular, none of the previous studies included large numbers of women with type 2 diabetes, which is a growing concern among women of childbearing age, especially those from disadvantaged ethnic groups or blacks and minorities.
Your study identifies maternal glycemia and body mass index (BMI) as the main modifiable risk factors in pregnant women with diabetes. How do doctors advise women with diabetes who are planning to become pregnant?
There is an important impact of the mother’s pre-pregnancy BMI on glucose levels during pregnancy, so I think encouraging women to optimize their dietary intake and enter a healthy pregnancy as close as possible before pregnancy is a very important component of pregnancy planning. both on T1 and T2D.
Should the emphasis be on making interventions before pregnancy, or can meaningful changes be made during pregnancy too?
During pregnancy, efforts can be made to limit excessive pregnancy weight gain, but it is too late to ‘undo’ the effects of BMI of being overweight / obese in early pregnancy.
Is there anything in particular that surprises you?
I was shocked about the impact of maternal weight on T1D. We already know that maternal glycemia is important, but I did not realize that early BMI has a strong influence on the glucose level of the mother during pregnancy and also on pregnancy outcome.
In T2D, I expected maternal obesity to have an impact, but was surprised by the impact of maternal glucose – which was much stronger than expected.
What is the main key for doctors?
The good news is that maternal glucose is relatively easy to change in T2D pregnancy, so the take-home message for me is to focus more on pre-pregnancy weight in T1D and on maternal glucose levels during pregnancy in T2D pregnancies.
Another key message is that changes are needed in all clinics to intensify glycemic management. In T1D that means recognition [continuous glucose management] for all pregnant women in all maternity clinics, and for T2D we need to be serious about pre-pregnancy diabetes prevention and weight management programs.