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Health news - Women with diabetes still more at risk of pregnancy complications26 June 2006 - written by Kate Nichols for Bupa's health information team Babies born to mothers with diabetes are more likely to die shortly after birth or have major birth defects, according to a study published online this month in the British Medical Journal. This is despite an international campaign to raise standards of care for people with diabetes. How was the study carried out?Researchers looked at what happened to babies of mothers who had type 1 or type 2 diabetes. Diabetes is a condition where the body cannot regulate blood sugar levels. They studied the records of 231 maternity units across England, Wales and Northern Ireland. Over a one-year period, they analysed 2359 pregnancies. They counted how many babies were born with birth defects, and how many died shortly after birth. To ensure accurate findings, the researchers only looked at pregnancies where the woman had been diagnosed with the condition at least one year before the estimated delivery date. What did the study show?Of the 2359 diabetic women studied, 1707 had type 1 diabetes and 652 had type 2 diabetes. The study found that women with type 2 diabetes were more likely to come from a Black, Asian or other ethnic-minority group and from a deprived area. The mortality rate for babies born to all diabetic mothers was nearly four times higher than that of the general maternity population. The results were evenly spread between mothers who had either type 1 or type 2 diabetes. Deaths occurred in 31.7 of 1000 births to mothers with type 1 diabetes. For type 2 sufferers, the figure was 32.3 deaths per 1000 births. For every 1000 babies born to diabetic mothers, 46 had major birth defects - more than double the number expected. Again, the risk was at a similar level for type 1 and type 2 sufferers. Most defects were related to the babies' hearts and nervous systems. How conclusive were the findings?Previous studies have shown that mothers with diabetes have an increased risk of giving birth to a baby that died, or had birth defects. But most of these studies focused on type 1 diabetes. The present study is considerably larger than any previous ones, and shows that women with type 2 diabetes face the same risks in pregnancy as women with type 1 diabetes. In the past, doctors have believed that type 2 diabetes is less serious than type 1. Incidence of type 2 diabetes is increasing among women of childbearing age in the UK. In conclusion, the authors expressed concern about the findings. They said that the risk of death and major birth defects has remained high despite an international strategy to raise standards in diabetes care. They want to raise further awareness of the increased risk of pregnancy complications faced by diabetic women. They also said more work was needed to find out how women with diabetes could improve their chances of a successful pregnancy. What did the authors advise pregnant women with diabetes to do?The authors said that diabetic women should take a high dose (5 mg) of folic acid from before conception to week 12 of pregnancy. Folic acid is found mainly in cereals and green, leafy vegetables, and can reduce the risk of a baby being born with neural-tube defects. They also suggested that pregnant women with diabetes should be routinely screened to check for heart defects in the fetus. How many pregnant women have diabetes in the UK?According to the Office of National Statistics there are over 600,000 births in England and Wales each year. The National Institute of Health and Clinical Excellence states that between 2 and 5 percent of these pregnancies involve mothers who have diabetes. What is the difference between type 1 and type 2 diabetes?Type 1 diabetes develops when the body cannot produce any insulin, because insulin-producing cells in the pancreas have been damaged or destroyed. It usually develops before the age of 40, often during puberty. Type 2 diabetes develops when the body can produce some insulin, but not enough. It can also develop if the insulin that is produced does not work properly. It usually affects people over the age of 40. Also, a growing number of children are developing the condition, which is often linked to obesity. Are women at more risk of developing diabetes than men?Men and women are equally likely to be diagnosed with all types of diabetes. Women are, however, more likely than men to die prematurely from diabetes. There is an increased prevalence of diabetes in young adults. Some pregnant women develop a temporary type of diabetes called gestational diabetes. This condition, or giving birth to a large baby (4 kg or heavier), can increase a woman's risk of developing diabetes later in life. Around 1 in 5 women suffer from a hormonal condition called polycystic ovary syndrome (PCOS). Symptoms can include irregular periods, obesity and increased body and facial hair. Women with diagnosed PCOS who are also obese have an increased risk of developing type 2 diabetes. What are the symptoms of diabetes?There are a number of symptoms that may indicate diabetes. These include:
What is the treatment for diabetes?Keeping your blood sugar levels as close to normal as possible is the best way to manage diabetes. Watching your diet and taking regular exercise is important. People with type 1 diabetes need to take regular insulin injections - usually three times a day. Some people use an insulin pump that works continuously. You may also need to measure your blood sugar levels three or four times each day. For people with type 2 diabetes, a good diet and exercise regime may be sufficient to treat the condition. However, the chances are you'll need to take diabetes tablets. If they don't work, you may need to take insulin. Your doctor will advise and monitor you. How exactly does diabetes affect the fetus in the womb?It is not completely understood how, or why, women with diabetes can affect the health of their unborn babies. However, some studies have suggested that high glucose levels in the bloodstreams of women at or around the time of conception may increase the risk of pregnancy complications. Apart from folic acid and regular screenings, are there any other things diabetic women can do to reduce the risks?If you are a woman with diabetes and planning a pregnancy, it is important to discuss matters with your doctor or diabetes care team. It should be remembered that many women with type 1, type 2 and gestational diabetes have successful pregnancies. However, it is essential to get appropriate advice. Diabetes UK recommend some ways to minimise the risk of damage to the fetus. These include controlling your blood sugar levels (particularly during the first eight weeks of pregnancy), eating a balanced diet, cutting down on alcohol and stopping smoking. Ask your GP or diabetes care team for fuller guidance. Bupa information
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