Abortion and Type 1 diabetes

natbatbbz1 · Sep 18, 2018

So random enough question.

If you’re following the news in Ireland, the eight amendment is now officially repealed.

As most of my life revolves around thinking about diabeties care, I had a quick look online to see if any medical journals or health guidelines were available for people with diabetes who seek abortions. And I found absolutely nothing from the main charities and the nhs.

Would anyone know where I would find such information?

Not looking a discussion on personal feelings regarding abortions, just curious to know what extra precautions doctors would advise on such a request.

For full disclosure I’m based in Northern Ireland were abortion is banned in nearly all circumstances. As the situation is in Northern Ireland, everyday women in Northern Ireland will illegally order pills from the internet, which are generally safe, but the unknowns are dangerous. Extra unknowns regarding chronic conditions increases risk and fears.

Fun reading I know but curious to see what info there is out there!

Guzzler · Sep 18, 2018

Perhaps BPAS (British Pregnancy Advisory Service) would have info or possibly links to info on their site.

natbatbbz1 · Sep 18, 2018

Guzzler said:
Perhaps BPAS (British Pregnancy Advisory Service) would have info or possibly links to info on their site.

Good shout but all I found on their site when searching for diabetes were things non related. Hmmmm

Guzzler · Sep 18, 2018

natbatbbz1 said:
Good shout but all I found on their site when searching for diabetes were things non related. Hmmmm

I remember this question being asked before so hold on until other members (especially those with T1) come up with more suggestions. Hope you find the answers as choice as to options are always most important.

EllieM · Sep 18, 2018

Most of the links I could find refer to spontaneous abortion possibly (or not) being more likely for T1s with poor blood sugars. I know there are no issues about prescribing the morning after pill for T1s. And there's a discussion here
https://www.diabetesforums.com/forums/topic/19889-diabetes-and-abortions/

kitedoc · Sep 19, 2018

Hi @natbatbbz1, Thank you for this question and I have some understanding of the complexity of the debate over women's rights vs religious, political and misogynistic interests. The following is my 'take' on what information I could find and does not represent medical advice or opinion.
In Diabetologia Dec 2017 - "Termination of pregnancy and sterilisation in women with childhood-onset Type 1 diabetes" Sjoberg L et al - 2281 such diabetics were matched against twice that number of healthy women, matched for age and birthplace. (the control group). I presume this is about European populations but the publishing company restrict access to the abstract only unless a subscription fee is paid.
The most recent data suggested that rate of legally performed sterilisations was similar between the groups but that legally performed termination of pregnancy was significantly more common in the diabetes group. Also maternal medical indications (reasons) for termination of pregnancy and sterilisation were < 1% in the control group vs 23.6% and 22.9% respectively in the diabetes group.
In Contraception 86 Guidelines - Society of Family Planning (2012) - 'First trimester abortion in women with medical conditions ' - (US based study) rates of all deaths from legal abortion are: < 8 weeks, 0.1per 100,000, > 12 weeks, 0.4 per 100,000.
It is noted that diabetes is listed as one medical condition which increases risk of adverse outcomes for mother and child in pregnancy and is a reason for some to undergo termination of pregnancy.
The paper states that outpatient, clinic setting for termination of pregnancy is safe for well-controlled diabetics.
The use of a medication form of termination of pregnancy is contra-indicated (advised as unsuitable) for persons with chronic adrenal failure, inherited porphyria and chronic long term use of steroids, also there are some drug interactions to be avoided. Heart conditions such as rheumatic fever etc were also contra-indications.
The specific risks to TIDs with the surgical form of termination of pregnancy includes the increased risk of hypoglycaemia in early pregnancy and avoiding this is an operative setting. No particular mention was made of increased risk of infection to diabetic women in legally performed termination of pregnancy procedures.
It was noted that diabetics with diabetes complications, eye. kidney, etc should not be prescribed combined hormonal therapy(the pill) as contraception.
I hope the above provides some information about the subject which I agree is difficult to find out about.
In reality it is not possible to discuss termination of pregnancy without including contraception.

natbatbbz1 · Sep 19, 2018

kitedoc said:
Hi @natbatbbz1, Thank you for this question and I have some understanding of the complexity of the debate over women's rights vs religious, political and misogynistic interests. The following is my 'take' on what information I could find and does not represent medical advice or opinion.
In Diabetologia Dec 2017 - "Termination of pregnancy and sterilisation in women with childhood-onset Type 1 diabetes" Sjoberg L et al - 2281 such diabetics were matched against twice that number of healthy women, matched for age and birthplace. (the control group). I presume this is about European populations but the publishing company restrict access to the abstract only unless a subscription fee is paid.
The most recent data suggested that rate of legally performed sterilisations was similar between the groups but that legally performed termination of pregnancy was significantly more common in the diabetes group. Also maternal medical indications (reasons) for termination of pregnancy and sterilisation were < 1% in the control group vs 23.6% and 22.9% respectively in the diabetes group.
In Contraception 86 Guidelines - Society of Family Planning (2012) - 'First trimester abortion in women with medical conditions ' - (US based study) rates of all deaths from legal abortion are: < 8 weeks, 0.1per 100,000, > 12 weeks, 0.4 per 100,000.
It is noted that diabetes is listed as one medical condition which increases risk of adverse outcomes for mother and child in pregnancy and is a reason for some to undergo termination of pregnancy.
The paper states that outpatient, clinic setting for termination of pregnancy is safe for well-controlled diabetics.
The use of a medication form of termination of pregnancy is contra-indicated (advised as unsuitable) for persons with chronic adrenal failure, inherited porphyria and chronic long term use of steroids, also there are some drug interactions to be avoided. Heart conditions such as rheumatic fever etc were also contra-indications.
The specific risks to TIDs with the surgical form of termination of pregnancy includes the increased risk of hypoglycaemia in early pregnancy and avoiding this is an operative setting. No particular mention was made of increased risk of infection to diabetic women in legally performed termination of pregnancy procedures.
It was noted that diabetics with diabetes complications, eye. kidney, etc should not be prescribed combined hormonal therapy(the pill) as contraception.
I hope the above provides some information about the subject which I agree is difficult to find out about.
In reality it is not possible to discuss termination of pregnancy without including contraception.

Thanks for this, all very interesting stats, still doesn’t give me a resource for termination advice and diabetes though. Thinking about this though I’m guessing it’s more down to lack of awareness outside a clinical setting, but I thought some of the diabetes websites might have have even mentioned guidelines or whether it’s just a case of proceed as normal. My hunt goes on

natbatbbz1 · Sep 19, 2018

EllieM said:
Most of the links I could find refer to spontaneous abortion possibly (or not) being more likely for T1s with poor blood sugars. I know there are no issues about prescribing the morning after pill for T1s. And there's a discussion here
https://www.diabetesforums.com/forums/topic/19889-diabetes-and-abortions/

Thanks! That thread was pretty much patchwork advise though, strange there’s not some easy access guide online.

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