Pre-pregnancy care can improve HbA1c levels in women with type 2 diabetes

A study conducted by researchers in Galway has shown that attendance at pre-pregnancy care programmes can help to reduce the risk of complications in women with type 2 diabetes and their children, Dr Rita Forde, lecturer in chronic diseases and reproductive health, King’s College London, told the recent Diabetes Ireland Conference and Exhibition (DICE) in Croke Park.

Quoting the Atlantic Diabetes in Pregnancy study, which involves hospitals within the Saolta Hospital Group and the National University of Ireland Galway, Dr Forde said that women with diabetes who attend pre-pregnancy care programmes in general fare better with their diabetes management than those who don’t. Since 2016, she told the conference, there has been a steady increase in the number of women with type 2 diabetes becoming pregnant in Ireland.

“This study has shown that pre-pregnancy care significantly reduces the risk of adverse outcomes in pregnancy, particularly in the infants of these women,” Dr Forde said.

Looking at UK data, specifically at the work of Dr Helen Murphy, professor of diabetes and antenatal care, University of East Anglia, UK, who runs a community-based diabetes pregnancy research programme, Dr Forde said that those women with type 2 diabetes in Dr Murphy’s group who attended pre-pregnancy care had significant improvements in their HbA1c, folic acid uptake pre pregnancy and a reduction in their use of potentially harmful medications prior to pregnancy.

“What these studies also highlight is that when compared to women with type 1 diabetes, women with type 2 diabetes fared worse in relation to their pregnancy and pre-pregnancy outcomes, even when receiving pre-pregnancy care,” Dr Forde added.

Both studies found that women with type 2 diabetes were more likely to be using teratogenic medications and were more likely to be entering pregnancy with overweight or obesity. There were also found to be significant discrepancies in folic acid use between women with type 1 and type 2 diabetes, according to Dr Forde.

Dr Murphy’s research indicated there is a lack of awareness of pre-pregnancy planning among the type 2 community and therefore these women are less likely to access pre-pregnancy care compared with their type 1 counterparts.

Addressing the stigma assocatied with the condition is a good place to start, Dr Forde said, as well as having conversations with young female patients with type 2 about their reproductive intentions.

Type 2 diabetes is often wrongly viewed as a condition of older age; however, it is becoming more and more common in those of a younger age, and in the case of women, childbearing potential. This can lead to feelings of stigma around viewing oneself as ‘abnormal’.

Dr Forde was keen to stress that most people with diabetes have “very healthy, normal babies”.

While the link between type 2 diabetes and cardiovascular disease is well known, the mental health issues associated with the condition are seldom discussed by comparison, particularly in the case of those diagnosed at an earlier age.

There are higher rates of depression and anxiety in the younger age group, who are also more likely to experience stigma in their dealings with healthcare professionals.

“We can unintentionally perpetuate stigmatising ideas among people with type 2 diabetes and a lot of it relates to the conflation between weight and type 2 diabetes,” Dr Forde said.

“We need to separate these two as they are entirely separate conditions, both of which require a sensitive approach. The message we should be portraying is that yes there are risks, but actually the majority of pregnancy outcomes in women with type 2 diabetes are good.”