As revealed by a new UK audit, there has been little progress in improving glucose control during pregnancy in women with type 1 or type 2 diabetes in recent years.
And so British experts have welcomed the announcement by the National Health Service (NHS) that continuous glucose monitoring (CGM), in the form of flash monitoring, will soon be available for all pregnant women with type 1 diabetes in England.
Speaking at the Diabetes UK Professional Conference: Online Series last week, Helen R. Murphy, MD, PhD, said that previous research, as reported by Medscape Medical News, has shown CGM is associated with increased time in A1c range for pregnant women with type 1 diabetes and improved neonatal outcomes.
Consequently, she is “delighted” by the announcement on November 13 that the NHS in England has provided funding for the provision of flash monitoring, a form of CGM, for all pregnant women with type 1 diabetes for 12 months.
The NHS says that approximately 2000 women will be eligible to receive flash monitoring to help control their A1c levels.
This is “a major step forward,” said Partha Kar, MD, associate national clinical director for diabetes for NHS England, in an NHS press release.
There are over 250,000 people with type 1 diabetes in England, and around 75,000 patients are already benefiting from the rapid roll out of the flash technology.
“This novel technology can make a massive difference for those living with diabetes,” and the expansion of availability “will have an instant effect for pregnant women,” said Kar, who is also a consultant in diabetes medicine at Portsmouth Hospitals NHS Trust.
Helen Kirrane, head of policy and campaigns at the charity Diabetes UK, said, “While healthcare services remain under enormous pressure,” due to the COVID-19 pandemic, “it is wonderful to see that pregnant women…will be getting the help they need to manage their condition as well as possible from home.”
Karen Addington, UK chief executive of the type 1 diabetes charity JDRF, added that pregnant women with type 1 diabetes “face particular challenges. That is why we are especially pleased by this milestone, achieved in large part thanks to JDRF research that showed CGM is cost-effective for pregnant women.”
Huge Rise in Prevalence of Type 2 Diabetes in Pregnancy
During her presentation at the virtual meeting, Murphy, of Norwich Medical School, University of East Anglia, reported on the National Pregnancy in Diabetes (NPID) Audit, which currently includes data on 17,375 pregnancies, approximately half of which are in women with type 2 diabetes.
She noted there has been a “huge rise” in the prevalence of type 2 diabetes in pregnancy over the last 20 years. “We are also, all of us, seeing more pregnancies in women with type 1 diabetes,” she said.
The data revealed that 700 women in the audit gave birth to babies with birth defects, the “vast majority” of which (n = 660) were major anomalies and, “as expected,” a substantial proportion (n = 260) were congenital heart disease.
Murphy said that “what is really striking and probably not surprising” is the “clear and linear association between maternal A1c levels in early pregnancy and increased risk of a serious adverse event.”
Although this association was already known in women with type 1 diabetes, “what is new and important is being able to show these data both for women with type 1 and for women with type 2 diabetes for the very first time,” Murphy added.
For stillbirth and neonatal deaths, the three most important risk factors were an A1c level > 48 mmol/mol (> 6.5%), at an odds ratio (OR) of 3.0, social deprivation (OR, 2.3), and maternal type 2 diabetes (OR, 1.65).
A1c level > 48 mmol/mol after 24 weeks of pregnancy was also associated with higher rates of preterm birth, large for gestational age babies, and neonatal intensive care unit admission, which was “particularly prevalent in type 1 diabetes,” Murphy said.
Pregnancy Planning Is Important
The audit also includes data on pre-pregnancy care, on which, “unfortunately, in relation to both type 1 and type 2 diabetes, there has been very little progress,” Murphy said.
However, there has been a reduction in the use of potentially harmful medications by women with type 2 diabetes during pregnancy, from 15% to 10%, while around 65% are taking metformin before pregnancy.
This “suggests they are having regular healthcare interactions,” Murphy said. “But it also means we need to do more to work closely with our colleagues in primary care to improve pregnancy preparation.”
She explained that, among women with diabetes who do not plan their pregnancy, the risk of serious complications such as stillbirth or a serious heart or birth defect is around 10%, but falls to approximately 2% in those who do plan their pregnancy.
The authors have reported no relevant financial relationships.