Type 1 diabetes and pregnancy
Type 1 diabetes is an autoimmune disease, which attacks the cells in the pancreas which produce insulin. Insulin is required to move glucose from the blood into cells and assist with the generation of energy.
Without insulin, glucose remains in the body at high levels. As opposed to type 2 diabetes, which is largely lifestyle driven, type 1 diabetes tends to develop in childhood.
Type 1 diabetes is a well known risk factor for adverse outcomes in pregnancy. Women with type 1 diabetes have a higher risk of miscarriage, obstetric interventions, congenital malformations, stillbirth and birth trauma, because the baby can be large.
Despite this knowledge, there are still gaps in the literature around pregnancy outcomes for women with type 1 diabetes. Specifically, the relationship between obesity and blood sugar control in women with type 1 diabetes is not well understood with relation to pregnancy outcomes. Researchers explored this relationship in a group of pregnant women in Melbourne.
Pregnant women with type 1 diabetes were compared to pregnant women with normal glucose tolerance.
Antenatal characteristics were analysed in addition to maternal and neonatal outcomes in the two groups. Maternal characteristics were also recorded. Outcomes included gestational size, induction of labour, delivery type, gestational hypertension and pre-eclampsia.
The women with type 1 diabetes had a higher mean body mass index (BMI) and higher rates of overweight or obesity compared to the women without type 1 diabetes.
Women with type 1 diabetes were found to have higher odds of giving birth to a baby who was large for its gestational age, and had greater likelihood of induction of labour and caesarean delivery. They also had higher rates of pre-term births, and their babies were more likely to have hypoglycaemia, jaundice and respiratory distress.
Increased BMI was associated with increased odds of congenital malformations and high birth weight after adjustment for age and HbA1C levels in the first trimester.
This study sheds further light on the increased risk of adverse birthing outcomes associated with type 1 diabetes. Furthermore, researchers found that obesity increased this risk even after adjustment for glycaemic control.
This highlights the importance of weight management strategies in women with type 1 diabetes particularly when trying to fall pregnant. If you are pregnant, or are trying to fall pregnant, and have type 1 diabetes talk to your doctor about the optimal strategies you can implement to control both weight and hyperglycaemia.
Last Reviewed: 30/10/2019
Norman Swan Medical Communications
Abell, S et al. (2016). Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control. MJA, 205, 162 – 167.