OP09.12: Incidence and types of fetal congenital malformations in women with type 1 and type 2 diabetes in pregnancy in a large multi-ethnic UK region

BACKGROUND Hyperglycemia in pregnancy occurs worldwide and is closely associated with health issues in women and their offspring, such as pregnancy and birth complications, respectively, as well as comorbidities, such as metabolic and cardiovascular diseases. To optimize the management of diabetic pregnancies, sustainable strategies are urgently needed. Investigation of constantly evolving technologies for diabetes that help to manage pregnancy and health is required. OBJECTIVE We aimed to conduct a systematic review to assess the clinical effectiveness of technologies for diabetes in pregnancy. METHODS Relevant databases including MEDLINE (PubMed), Cochrane Library, Embase, CINAHL, and Web of Science Core Collection were searched in September 2020 for clinical studies (2008-2020). Findings were organized by type of diabetes, type of technology, and outcomes (glycemic control, pregnancy- and birth-related outcomes, and neonatal outcomes). Study quality was assessed using Effective Public Health Practice Project criteria. RESULTS We identified 15 randomized controlled trials, 3 randomized crossover trials, 2 cohort studies, and 2 controlled clinical trials. Overall, 9 studies focused on type 1 diabetes, 0 studies focused on gestational diabetes, and 3 studies focused on both type 1 diabetes and type 2 diabetes. We found that 9 studies were strong quality, 11 were moderate quality, and 2 were weak quality. Technologies for diabetes seemed to have particularly positive effects on glycemic control in all types of diabetes, shown by some strong and moderate quality studies. Positive trends in pregnancy-related, birth-related, and neonatal outcomes were observed. CONCLUSIONS Technologies have the potential to effectively improve the management of diabetes during pregnancy. Further research on the clinical effectiveness of these technologies is needed, especially in pregnant women with type 2 diabetes.

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Diabetes in pregnancy

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0013 ◽

2020 ◽

pp. 163-169

Author(s):

Michael Permezel ◽

Alexis Shub

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Obese Women ◽

Diabetes In Pregnancy ◽

Clinically Significant ◽

In Pregnancy

The importance of diabetes in pregnancy arises through two unrelated phenomena: an increased predisposition to impaired glucose tolerance in late pregnancy and an adverse impact of the increased glucose on important obstetric outcomes. There are marked differences in clinical outcomes and management between pregnancies in which a clinically significant impairment of glucose tolerance was first noticed during pregnancy (‘gestational diabetes mellitus’) and those where type 1 or type 2 diabetes mellitus had been known prior to pregnancy (‘prepregnancy diabetes’). Historically, GDM has been defined as the diagnosis of clinically significant impaired glucose tolerance in pregnancy in a woman not previously known to be diabetic. This has recently been complicated by recognizing that some diabetes mellitus will present for the first time in pregnancy and lack of clarity as to where the lower threshold for diagnosis should best be placed. Type 1 diabetes is present in approximately 0.2% of pregnant women, and the numbers are largely stable. In contrast, type 2 diabetes was once uncommon in pregnancy but is now also as high as 0.2%. This is likely to continue to increase as increased numbers of overweight and obese women enter the reproductive years. Prepregnancy diabetes provides the model of how pregnancy and maternal disease impact on each other, and how good preconception, antenatal and intrapartum care can make an enormous difference for these women and their babies.

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