Type-1 Diabetes: Rising Trend Observed Among Pregnant Women

Prevalence of type-1 diabetes during pregnancy has risen over the past decade. Obstetric care has improved the length of pregnancy and mode of delivery in women with type-1 diabetes but, other outcomes like excessive weight gain, fetal macrosomia, and large for gestational babies need more attention.

Prevalence of type 1 diabetes during pregnancy has doubled in the past few decades in the U.S. The time trends in pregnancy-related outcomes such as length of pregnancy, mode of delivery, and weight gain among women with type 1 diabetes were investigated between 2004 and 2017 and the findings are published in the Journal of Perinatology.

The findings reveal that the percentage of mothers with excess weight gain during pregnancy as well as the used of insulin pumps increased significantly. The prevalence of diabetic nephropathy fell to zero and a trend towards pre-pregnancy obesity rose dramatically in this population. Also the percentage of very large babies born also known as fetal macrosomia, remained the same.

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‘Percentage of women with type-1 diabetes before pregnancy has gone up by 40 percent in the last two decades. Optimal control of blood sugar level before and during pregnancy in women with diabetes is essential for improving pregnancy and delivery outcomes.’
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The pregnancies complicated by type 1 diabetes have a higher prevalence of cesarean section, preterm birth, and macrosomia and incur higher health care costs.

The percentage of women with type 1 diabetes before pregnancy has climbed nearly 40% in the past two decades, according to the Centers for Disease Control and Prevention.

"Originally, our aim was to look at why women with type 1 diabetes have large birth weight babies, and to determine whether the prevalence of babies born very large has changed over the years in our population," says Florence Brown, MD, study coauthor and Co-Director of the Joslin and Beth Israel Deaconess Medical Center Diabetes in Pregnancy Program in Boston. "To understand this relationship, it is necessary to understand the influence of a broad number of variables."

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Type 1 diabetes is a condition most common in children in which the pancreas stops producing and releasing the hormone insulin that controls blood sugar levels.

For the study, researchers reviewed medical records of 700 pregnant women with type 1 diabetes who attended the Joslin Diabetes Center and Beth Israel Deaconess Medical Center Diabetes in Pregnancy Program between 2004 and 2017. Currently, this is the largest U.S. database on pregnant women with type 1 diabetes.

Researchers analyzed data on treatment, delivery and neonatal outcomes, as well as the mothers' glucose levels, gestational weight gain and other maternal factors that impact outcomes in pregnancy. To calculate trends in these areas over time, patients were divided into three groups based on their delivery date: 2004 to 2008; 2009 to 2012; and 2013 to 2017. Researchers then compared changes over these time periods.

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The study revealed that A1c levels of the mothers remained steady in each trimester across the entire study period, the prevalence of diabetic nephropathy fell dramatically, dropping from 4.8% in 2004 -2008 to 0% in 2013-2017, the percentage of mothers with excessive gestational weight gain increased by about 10% from 2004-2008 to 2013-2017. "This underscores the need to address BMI prior to pregnancy, making sure women have regular nutrition counseling to achieve weight goals," says Brown.

They found that the length of pregnancy increased slightly over time, and the number of vaginal deliveries rose from about 21% in the early years of the study to 29% in the later years. The prevalence of babies born very large remained high throughout the study period. These babies are at greater risk for later-life metabolic diseases, says Brown.

Healthy Weight Gain during Pregnancy
Recommended weight gain during pregnancy is determined as per pre-pregnancy weight and BMI. Healthy weight gain is very important for pregnancy health and is achieved with the right diet and exercise.

Insulin pump use increased by about 23% between 2004 and 2017. In addition, CGM use also rose, from no use at the start of the study to nearly 40% during the later years of the study. "Our next study will look at the differences in women who use insulin pumps and CGMs and how that use effects diabetes control and neonatal outcomes," says Brown.

These findings are important because they are a stepping stone to our next analysis, says Brown. "This is the first time we've really been able to paint a big picture, and identify the clues as to which factors may be associated with large birthweight, such as maternal BMI, maternal gestational weight gain and A1c levels."

Source-Eurekalert