Type 1 and Type 2 Diabetes Preconception and in Pregnancy: Health Impacts, Influence of Obesity and Lifestyle, and Principles of Management

Abstract

Preexisting diabetes in pregnancy results in increased risks to the mother, fetus, and neonate. Preconception care is vital to reduce risk of miscarriage, congenital malformations, and perinatal mortality. Preconception care should empower women with realistic goal setting, healthy lifestyle, and diabetes self-management skills, to ensure a positive experience of the pregnancy and to reduce diabetes-related distress. In high-risk women without known diabetes, preconception and early antenatal screening is crucial to enable prompt treatment of hyperglycemia and any complications. The prevalence of obesity in reproductive age women is rising, further increasing risk of poor pregnancy outcomes in women with diabetes. Adverse lifestyle factors should be addressed preconception and in the antenatal period, allowing opportunity to improve physical health, manage weight, and improve neonatal outcomes. Management of diabetes in pregnancy involves individualized and intensified insulin therapy, accounting for expected changes in insulin sensitivity, and minimizing glucose variability and hypoglycemia. Diabetes complications must be screened for and managed as necessary. Delivery timing will depend on fetal surveillance and obstetric considerations. It is important to maintain engagement and motivation of these women in the postpartum period, encouraging breastfeeding and postpartum weight management and supporting diabetes management.

Preconception management of women with obesity: A systematic review

“…Catalano et al has shown that even women with obesity who gain inadequate weight during pregnancy (<5 kg) have a significantly increased risk of SGA infants . These infants carry the same long‐term metabolic risks as LGA infants . Women should therefore be supported to gain weight during pregnancy according to the 2013 Institute of Medicine guidelines .…”

Metformin in the management of diabetes during pregnancy and lactation

“…With the rising prevalence of T2D, decreasing age at onset of the disease and rising maternal age at pregnancy [ 9 ], a significant number of pregnant women have pre-existing T2D [ 10 ]. They are often obese and have high rates of maternal morbidity, including pregnancy-induced hypertension (PIH), preeclampsia and Caesarian delivery [ 11 ]. Infants of diabetic mothers have higher rates of LGA and macrosomia and an increased perinatal morbidity and mortality [ 12 ].…”

Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care

“…While Aboriginal and Torres Strait Islander women tend to have babies at younger ages than non-Indigenous women [ 1 ], risk factors for non-communicable diseases (NCDs) are already common among young Aboriginal and Torres Strait Islander women [ 2 ]. Smoking, high-risk alcohol use, obesity, underweight, poor nutrition and gestational diabetes are risk factors for both adverse pregnancy outcomes and NCDs that are more common among Aboriginal and Torres Strait Islander women than non-Indigenous women [ 1 , 3 – 7 ]. This is consistent with a life expectancy of 10 years less for Aboriginal and Torres Strait Islander women, predominantly due to NCDs [ 5 ].…”