Diabetes, Pregnancy Risks, and Birth Defects

Planned pregnancy a must
The charity Diabetes UK funded the study. Its director of research, Dr. Iain Frame, said, “We need to get the message out to women with diabetes that if they are considering becoming pregnant, then they should tell their diabetes healthcare team, who will make sure they are aware of planning and what next steps they should be taking.”

His thoughts were shared by the lead author. The study “also highlights the importance of using contraception if you are a woman with diabetes who is sexually active but not planning to become pregnant,” Dr. Bell said.

Commenting on the study, NHS said that women with diabetes are likely aware of the risks their condition poses. “However, this study provides another reminder that diabetic women who are thinking about becoming pregnant should discuss their options with their doctor first,” it added.

How was the research undertaken?
Using data collected from 401,000 pregnancies that occurred between 1996 and 2008, the Newcastle researchers looked at whether mothers had diabetes, and if their babies had birth defects. They then looked at whether birth defects were more common in babies born to mothers with diabetes.

The researchers got their data registries of the Northern Diabetes in Pregnancy Survey (NorDIP) and the Northern Congenital Abnormality Survey (NorCAS) in the north of England. NorDIP included data on pregnancies in women diagnosed with diabetes at least six months before conception, but doesn’t include women with gestational diabetes or diabetes that only occurs in pregnancy.

Looking at all eligible births in the study region in the study period, researchers then excluded from the study multiple pregnancies and included pregnancies where the baby died at or before 20 weeks of pregnancy and those that were terminated due to a fetal abnormality.

Abnormalities were classified according to standard definitions, and could be recorded up to the age of 12 years. Birth abnormalities caused by problems with the number or structure of chromosomes were looked at separately.

The researchers looked at the effect of various diabetes-related factors including:
• how well the woman’s blood sugar was controlled at around the time of conception
• whether she had type 1 or type 2 diabetes
• diabetes complications diagnosed before pregnancy like kidney or eye problems

They also took into account the following factors:
• maternal age at the time of delivery
• gestational age at time of delivery
• folic acid intake before conception
• fetal gender
• number of previous babies
• pre-pregnancy care
• smoking during pregnancy

NHS advice
The NHS said the study highlighted the need for health providers to provide diabetic women with information on the importance of planning future pregnancies, as well as specialist care and advice on having a baby, from the moment they become teenagers.

For women with diabetes, the importance of avoiding unplanned pregnancy should be part of diabetes education from adolescence onwards.

It’s best if women with very poor control of blood sugar levels don’t get pregnant until their sugar control has improved, the NHS also said. In particular, women with an HbA1c of over 10 percent should avoid becoming pregnant.

Women with diabetes who are trying to conceive or planning to become pregnant should:
• Establish good blood sugar control before conception.
• Maintain good blood sugar throughout pregnancy.
• Aim for an HbA1c of less than 6.1 percent , if this can be achieved safely.
• Obtain pre-conception care and advice from a heath provider before they stop using contraception.

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