Type 1 Diabetes in Pregnancy: A Review of Complications and Management

Current Diabetes Reviews ◽

10.2174/1573399818666211105124829 ◽

2021 ◽

Vol 18 ◽

Author(s):

Farah Jaffar ◽

Kate Laycock ◽

Mohammed S.B. Huda

Keyword(s):

Type 1 Diabetes ◽

Microvascular Disease ◽

Evidence Based ◽

Current Guideline ◽

Diabetes In Pregnancy ◽

Fetal Outcomes ◽

Increased Risk ◽

Fetal Complications ◽

In Pregnancy

Background: Pre-gestational diabetes can pose significant risk to the mother and infant, thus requiring careful counselling and management. Since Saint Vincent’s declaration in 1989, adverse maternal and fetal outcomes, such as preeclampsia, perinatal mortality, congenital anomalies, and macrosomia, continue to be associated with type 1 diabetes. Although pregnancy is not considered an independent risk factor for the development of new onset microvascular complications, it is known to exacerbate pre-existing microvascular disease. Strict glycaemic control is the optimal management for pre-existing type 1 diabetes in pregnancy, as raised HbA1C is associated with increased risk of maternal and fetal complications. More recently, time in range on Continuous Glucose Monitoring glucose profiles has emerged as another useful evidence-based marker of fetal outcomes. Objective: This review summarises the complications associated with pre-gestational type 1 diabetes, appropriate evidence-based management, including preparing for pregnancy, intrapartum and postpartum care. Methods: A structured search of the PubMed and Cochrane databases was conducted. Peer-reviewed articles about complications and management guidelines on pre-gestational type 1 diabetes were selected and critically appraised. Results: One hundred and twenty-three manuscripts were referenced and appraised in this review, and international guidelines were summarised. Conclusion: This review provides a comprehensive overview of the recurring themes in the literature pertaining to type 1 diabetes in pregnancy: maternal and fetal complications, microvascular disease progression, and an overview of current guideline-specific management.

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Emerging Technologies for the Management of Type 1 Diabetes in Pregnancy

Current Diabetes Reports ◽

10.1007/s11892-018-0973-9 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Jennifer M. Yamamoto ◽

Helen R. Murphy

Keyword(s):

Type 1 Diabetes ◽

Emerging Technologies ◽

Diabetes In Pregnancy ◽

In Pregnancy

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CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center, multi-national, randomized controlled trial - Study protocol

BMC Pregnancy and Childbirth ◽

10.1186/s12884-016-0961-5 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 23

Author(s):

Denice S. Feig ◽

◽

Elizabeth Asztalos ◽

Rosa Corcoy ◽

Alberto De Leiva ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Type 1 Diabetes ◽

Continuous Glucose Monitoring ◽

Study Protocol ◽

Controlled Trial ◽

Glucose Monitoring ◽

Diabetes In Pregnancy ◽

Randomized Controlled ◽

In Pregnancy

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Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes

10.2337/figshare.14356943.v1 ◽

2021 ◽

Author(s):

Rose Gubitosi-Klug ◽

Xiaoyu Gao ◽

Rodica Pop-Busui ◽

Ian H de Boer ◽

Neill White ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Kidney Disease ◽

Microvascular Complications ◽

Microvascular Disease ◽

Fundus Photography ◽

Increased Risk ◽

Subsequent Risk

Objective: We examined whether the presence of microvascular complications was associated with increased subsequent risk of cardiovascular disease (CVD) among participants with type 1 diabetes in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study followed for over 35 years. Research Design and Methods: Standardized longitudinal data collection included: 1) stereoscopic seven-field retinal fundus photography centrally-graded for retinopathy stage and clinically significant macular edema; 2) urinary albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR); 3) cardiovascular autonomic neuropathy (CAN) reflex testing; and 4) adjudicated CVD events, including death from cardiovascular disease, nonfatal myocardial infarction, stroke, subclinical myocardial infarction on ECG, confirmed angina, or coronary artery revascularization. Cox proportional hazard models assessed the association of microvascular complications with subsequent risk of CVD. Results: 239 participants developed CVD, including 120 participants who suffered major adverse cardiovascular events (MACE) defined as non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. The presence of microvascular disease (diabetic retinopathy, kidney disease, or CAN) was associated with increased risk of subsequent CVD and MACE (hazard ratios 1.86 to 3.18 and 2.09 to 3.63, respectively); associations that remained significant after adjusting for age and HbA1c. After adjustment for traditional CVD risk factors, however, only sustained AER≥30 mg/24hr occurring alone and/or with eGFR<60 ml/min/1.73m, and the presence of both retinal and kidney disease remained associated with CVD. Conclusions: Advanced microvascular disease, especially moderate to severe albuminuria or eGFR<60 ml/min/1.73m2, conveyed an increased risk of subsequent cardiovascular disease in the DCCT/EDIC cohort.

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Clinical Effectiveness of Different Technologies for Diabetes in Pregnancy: Systematic Literature Review (Preprint)

10.2196/preprints.24982 ◽

2020 ◽

Author(s):

Claudia Eberle ◽

Maxine Loehnert ◽

Stefanie Stichling

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Clinical Effectiveness ◽

Neonatal Outcomes ◽

Diabetes In Pregnancy ◽

Pregnancy And Birth ◽

In Pregnancy

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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