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The Challenges and Future Considerations Regarding Pregnancy-Related Outcomes in Women with Pre-Existing Diabetes

Current Diabetes Reports volume 13, pages 869–876 (2013)Cite this article

Abstract

Ineffective management of blood glucose levels during preconception and pregnancy has been associated with severe maternal and fetal complications in women with pre-existing diabetes. Studies have demonstrated that preconception counseling and pre-pregnancy care can dramatically reduce these risks. However, pregnancy-related outcomes in women with diabetes continue to be less than ideal. This review highlights and discusses a variety of patient, provider, and organizational factors that can contribute to these suboptimal outcomes. Based on the findings of studies reviewed and authors’ clinical and research experiences, recommendations have been proposed focusing on various aspects of care provided, including improved accessibility to effective preconception and pregnancy-related care and better organized clinic consultations that are sensitive to women’s diabetes and pregnancy needs.

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Acknowledgments

Helen R. Murphy is funded by a research fellowship supported by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Lee Ritterband has been awarded an R21 grant by NIH/NIDDK to develop and test the feasibility of an Internet intervention to assist women with type 1 diabetes contemplating pregnancy better regulate their blood glucose levels in preparation for pregnancy. She is a part equity owner of BeHealth Solutions, LLC, a company who licenses software from UVA and makes this software and services for evidence-based clinical research and who are working to expand public access to proven eHealth interventions. This software includes a platform to build and host Internet interventions as well as 2 interventions developed by Dr. Ritterband and his team (1 for pediatric encopresis and 1 for adults with insomnia). Although none of this is explicitly discussed in this paper, within the Recommendation section, mention is made of accessing care via the Internet. Dr. Ritterband's wife, Dawn Ritterband, provides consultation to BeHealth Solutions, LLC.

Harsimran Singh has been awarded an R21 grant by NIH/NIDDK to develop and test the feasibility of an Internet intervention to assist women with type 1 diabetes contemplating pregnancy better regulate their blood glucose levels in preparation for pregnancy.

Compliance with Ethics Guidelines

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Conflict of Interest

Harsimran Singh declares that he has no conflict of interest.

Helen R. Murphy serves on the Medtronic European Advisory Board.

Christel Hendrieckx declares that she has no conflict of interest.

Lee Ritterband declares that she has no conflict of interest.

Jane Speight serves on the Accu-Chek Advisory Board, Roche Diagnostics Australia, and also Sanofi Aventis, Roche Diagnostics Australia (both relating to diabetes management but not specifically to pregnancy issues). She has received grant support from Sanofi Aventis (relating to diabetes management but not specifically to pregnancy issues). She has also received payment for development of educational presentations including service on speakers' bureaus from Sanofi Diabetes, Abbott Diabetes Care, and Roche Diagnostics (relating to diabetes management but not specifically to pregnancy issues). She also received travel expenses provided to support her attendance at a DAWN-2 Study meeting from Novo Nordisk (relating to diabetes management but not specifically to pregnancy issues).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Psychiatry and Neurobehavioral Sciences, Division of Behavioral Health and Technology, University of Virginia School of Medicine, 310 Old Ivy Way, Suite 102, Charlottesville, VA, 22903, USA

    Harsimran Singh & Lee Ritterband

  2. Metabolic Research Laboratories and NIHR Cambridge Biomedical Center, Level 4, Institute of Metabolic Science, Box 289 Addenbrookes Hospital, Cambridge, CB2 0QQ, UK

    Helen R. Murphy

  3. The Australian Center for Behavioural Research in Diabetes, Diabetes Australia–Vic, 570 Elizabeth Str, Melbourne, 3000, Australia

    Christel Hendrieckx & Jane Speight

  4. Center for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia

    Christel Hendrieckx & Jane Speight

  5. AHP Research, Uxbridge, UK

    Jane Speight

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  1. Harsimran Singh
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  2. Helen R. Murphy
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  3. Christel Hendrieckx
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Correspondence to Harsimran Singh.

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Singh, H., Murphy, H.R., Hendrieckx, C. et al. The Challenges and Future Considerations Regarding Pregnancy-Related Outcomes in Women with Pre-Existing Diabetes. Curr Diab Rep 13, 869–876 (2013). https://doi.org/10.1007/s11892-013-0417-5

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Keywords

  • Pregnancy
  • Pre-existing diabetes
  • Congenital malformations
  • Preconception counseling
  • Gestational
  • Prepregnancy care
  • Contraception
  • Glycemic control
  • High-risk pregnancy
  • Distress
  • Fetal outcomes
  • Stillbirth
  • Neonatal death
  • Newborn
  • Motherhood