Type 2 Diabetes and Fetal Complications

Diabetics face increased risk of stillbirth, congenital anomalies

(RxWiki News) A new study from researchers at St. Michael’s Hospital , the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital indicates women with type 2 diabetes face more complications during pregnancy, and almost half of them undergo potentially avoidable C-sections. The study also suggests diabetic women’s babies are twice as likely to die as those born to women without diabetes.

As more women develop type 2 diabetes – rates have doubled in the past 12 years in Ontario, according to the study – pregnancy complications have become increasingly common. Nearly 1 in 10 adults in Ontario has been diagnosed with adult onset (type 2) diabetes. 

“With more women having babies later in life, we are seeing a greater number of women getting pregnant with diabetes,” said Dr. Lorraine Lipscombe, a scientist at the Women's College Research Institute at Women's College Hospital and ICES.

The POWER (Project for an Ontario Women's Health Evidence-Based Report) study found that babies born to women with pre-pregnancy diabetes experience twice the fetal complications as those born to women without diabetes, and rates of congenital anomalies are about 60 percent higher for women with the disease.

Perhaps most troubling, women with pre-pregnancy diabetes are twice as likely to experience stillbirth or in-hospital mortality than those without diabetes.

Dr. Gillian Booth, scientist for St. Michael's Hospital and ICES, said these higher risks for complications can be prevented by controlling glucose and blood pressure levels at the time of conception and during pregnancy.

“This reflects a need for more targeted pre-pregnancy counselling and better pregnancy care for this group of women,” Booth said.

Some 45 percent of women with pre-gestational diabetes have caesarian surgery compared with 37 percent of women who develop diabetes during pregnancy (gestational diabetes).

For women who don’t develop diabetes before or during pregnancy, researchers have discovered that those who breastfeed are half as likely to develop the disease. Excess weight mothers gain during pregnancy is more easily lost when breastfeeding, which may help explain the finding.

A report in Time Magazine indicates breastfeeding can increase a mother's response to insulin, allowing her to break down glucose more effectively and keep sugar metabolism in check.”

Lactation also inhibits hormones that promote growth hormone activity that may also affect insulin levels, according to the same report.

Breastfeeding is also shown to lower risks for developing heart disease, reproductive cancers and rheumatoid arthritis, according to U.S. News & World Report.

Principal investigator of the POWER study, Arlene Bierman, a physician at St. Michael’s hospital, said most type 2 diabetes can be prevented. A healthy diet, exercise and controlling insulin levels are among the most effective measures to ward off the disease. 

"We need to focus on preventing or reducing rates of diabetes among young women, one of the most vulnerable groups, and ensure that women who have diabetes get effective treatment,” Bierman said.

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September 21, 2010