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Improved insulin management could reduce larger babies in type 1 diabetes pregnancies

Women with type 1 diabetes who take less insulin daily but still maintain good blood sugar control could avoid having large birth weight babies, research suggests.
US scientists have discovered that pregnant women with type 1 diabetes were more at risk of giving birth to large infants (known as excessive fetal growth) even if they had excellent glycemic control.
Large birth weight in infants, also known as macrosomia, can lead to extra difficulties and complications for the mother and baby. These can include difficulties delivery the baby, labour needing to be induced or need for a caesarean section. However, many mothers are able to give birth to larger babies without these problems.
The findings, published in the journal Diabetes Technology % Therapeutics (DTT), are disconcerting, but indicate that improved methods of insulin delivery could help prevent prenatal and maternal complications.
“Fetal macrosomia continues to be a problem in patients with type 1 diabetes associated with pregnancy despite improvements in overall glucose control,” said Chief Satish Garg, MD, Editor of DTT and Professor of Medicine and Pediatrics at the University of Colorado Denver (Aurora).
“With the availability of a hybrid-closed loop system, it will be important to see if fetal overweight can be reduced with automatic delivery of insulin based on sensor glucose values.”
In the study 41 pregnant women with type 1 diabetes were equipped with continuous glucose monitoring over a 7-day period in each trimester. The researchers monitored a range of clinical data from medical records and evaluated signs of complications.
The mean HbA1c of the women was 6.5% in the first trimester, 6.1% in the second and 6.4% in the third. Despite this good control, 63% of infants were large for gestational age.
However, once maternal age was accounted for, blood sugar variety was not associated with birth weight for any trimester.
“Since large gestational age is a key driver of maternal and newborn complications in pregnancies with Type 1 DM, our data emphasize the importance of investigating both glucose-dependent and glucose-independent underlying mechanisms,” said the researchers.
Benedict Jephcote, Editor of Diabetes.co.uk, said: “We know that high insulin levels through pregnancy can increase the risk of a larger baby. This is why women with gestational diabetes also have higher incidence of larger infants.
“A small change to dietary intake could allow for slightly less insulin being required through the pregnancy, which can reduce the risk of a larger baby. It is important that any significant dietary changes are discussed with a dietitian or your health team to ensure they are appropriate for your pregnancy.”

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