Experts have called for a greater focus on pre-conception weight in childbearing women with type 1 diabetes after finding obesity and overweight were independent and synergistic risk factors for adverse pregnancy and neonatal outcomes.
“Optimising glycaemic control alone is not enough to prevent complications associated with type 1 diabetes during pregnancy,” wrote the researchers in their study published in the Medical Journal of Australia.
Dr Sally Abell, an endocrinologist at the diabetes unit at Monash Health in Melbourne and co-author of the research, said their findings highlighted the need for a greater focus on educating women about the importance of weight pre-conception.
“By the time we see women at 8 or 12 weeks gestation, we’re already playing catch up,” she told the limbic.
“It’s a race to get their HbA1c down to about 6% but also to get their weight down…two points of BMI makes a big difference to these women.”
The historical cohort study compared 107 pregnancies of women with type 1 diabetes to 27 075 pregnancies of women without diabetes.
Results showed that despite optimal glycaemic control women with diabetes had seven times the rate of preterm births compared to women without diabetes.
Women living with diabetes were also three times more likely to have an induced labour and five times more likely to have a caesarian section.
The infants of women with type 1 diabetes were eight times more likely to be large for gestational age and experience more complications including shoulder dystocia, hypoglycaemia, jaundice, respiratory distress or perinatal death.
But the study also found that within the diabetes group, every 1 kg/m2 increase in BMI was associated with a 50 per cent increase in congenital malformations.
“The research shows that type 1 diabetes is still associated with adverse pregnancy outcomes even in women with good glycaemic control managed in a specialised multidisciplinary setting,” Dr Abell said.
She said along with the option of continuous glucose monitoring, closer monitoring of gestational weight gain was important to improve outcomes in women with diabetes.
“There is lots of data supporting recommendations for women without diabetes regarding gestational weight gain per BMI category but no studies in women with type 1, type 2 or gestational diabetes,” she added.