Diabetes in pregnancy: a new decade of challenges ahead

Ute Schaefer-Graf, Angela Napoli, Christopher J Nolan, Diabetic Pregnancy Study Group, Ute Schaefer-Graf, Angela Napoli, Christopher J Nolan, Diabetic Pregnancy Study Group

Abstract

Every 10 years, the Diabetic Pregnancy Study Group, a study group of the EASD, conducts an audit meeting to review the achievements of the preceding decade and to set the directions for research and clinical practice improvements for the next decade. The most recent meeting focused on the following areas: improving pregnancy outcomes for women with pregestational type 1 diabetes and type 2 diabetes; the influence of obesity and gestational diabetes on pregnancy outcomes; the determinants and assessment of fetal growth and development; and public health issues, including consideration of transgenerational consequences and economic burden. The audit meeting also considered the likely impact of 'omics' on research within the field and the potential of these technologies to enable precision-medicine approaches to management. Through sharing of the findings and ideas of audit meeting participants, the DPSG hopes to promote networking, research and advances in clinical care, to improve outcomes for all women and their offspring affected by diabetes and obesity in pregnancy.

Keywords: Fetus; Gestational diabetes mellitus; Obesity; Placenta; Pregnancy; Review; Type 1 diabetes; Type 2 diabetes.

Conflict of interest statement

The authors declare that there is no duality of interest associated with this manuscript.

References

    1. Colstrup M, Mathiesen ER, Damm P, Jensen DM, Ringholm L. Pregnancy in women with type 1 diabetes: have the goals of St. Vincent declaration been met concerning foetal and neonatal complications? J Matern Fetal Neonatal Med. 2013;26:1682–1686. doi: 10.3109/14767058.2013.794214.
    1. Macintosh MC, Fleming KM, Bailey JA, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006;333:177. doi: 10.1136/.
    1. Murphy HR, Bell R, Cartwright C, et al. Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia. 2017;60:1668–1677. doi: 10.1007/s00125-017-4314-3.
    1. Wahabi HA, Alzeidan RA, Esmaeil SA. Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health. 2012;12:792. doi: 10.1186/1471-2458-12-792.
    1. Scheffler RM, Feuchtbaum LB, Phibbs CS. Prevention: the cost-effectiveness of the California Diabetes and Pregnancy Program. Am J Public Health. 1992;82:168–175. doi: 10.2105/AJPH.82.2.168.
    1. NHS Digital (2016) National Diabetes in Pregnancy Audit. Available from . Accessed 16 Oct 2017
    1. Tieu J, Middleton P, Crowther CA, Shepherd E (2017) Preconception care for diabetic women for improving maternal and infant health. Cochrane Database Syst Rev, Issue 8, Art. no.: CD007776
    1. Egan AM, Galjaard S, Maresh MJA, et al. A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes. Diabetologia. 2017;60:1190–1196. doi: 10.1007/s00125-017-4277-4.
    1. Maresh MJ, Holmes VA, Patterson CC, et al. Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes. Diabetes Care. 2015;38:34–42. doi: 10.2337/dc14-1755.
    1. Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care. 2013;36:1877–1883. doi: 10.2337/dc12-2360.
    1. American Diabetes Association Management of diabetes in pregnancy. Diabetes Care. 2017;40:S114–S119. doi: 10.2337/dc17-S016.
    1. National Institute for Health and Care Excellence (NICE) (2015). Diabetes in pregnancy: management from preconception to the postnatal period. Available from /guidance/ng3. Accessed 16 Oct 2017
    1. Farrar D, Tuffnell DJ, West J, West HM (2016) Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database Syst Rev, Issue 6, Art. no.: CD005542
    1. Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017;390:2347–2359. doi: 10.1016/S0140-6736(17)32400-5.
    1. Stewart ZA, Wilinska ME, Hartnell S, et al. Closed-loop insulin delivery during pregnancy in women with type 1 diabetes. N Engl J Med. 2016;375:644–654. doi: 10.1056/NEJMoa1602494.
    1. Fresa R, Visalli N, Di Blasi V, et al. Experiences of continuous subcutaneous insulin infusion in pregnant women with type 1 diabetes during delivery from four Italian centers: a retrospective observational study. Diabetes Technol Ther. 2013;15:328–334. doi: 10.1089/dia.2012.0260.
    1. Ringholm L, Mathiesen ER, Kelstrup L, Damm P. Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding. Nat Rev Endocrinol. 2012;8:659–667. doi: 10.1038/nrendo.2012.154.
    1. Bell R, Glinianaia SV, Tennant PW, Bilous RW, Rankin J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia. 2012;55:936–947. doi: 10.1007/s00125-012-2455-y.
    1. Zeisler H, Llurba E, Chantraine F, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med. 2016;374:13–22. doi: 10.1056/NEJMoa1414838.
    1. Concillado M, Lund-Andersen H, Mathiesen ER, Larsen M. Dexamethasone intravitreal implant for diabetic macular edema during pregnancy. Am J Ophthalmol. 2016;165:7–15. doi: 10.1016/j.ajo.2016.02.004.
    1. Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4:1025–1036. doi: 10.1016/S2213-8587(16)30217-0.
    1. Catalano PM, Mele L, Landon MB, et al. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth? Am J Obstet Gynecol. 2014;211:137 e131-137. doi: 10.1016/j.ajog.2014.02.004.
    1. Hinkle SN, Sharma AJ, Dietz PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr. 2010;92:644–651. doi: 10.3945/ajcn.2010.29726.
    1. Abenhaim HA, Alrowaily N, Czuzoj-Shulman N, Spence AR, Klam SL. Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women. J Matern Fetal Neonatal Med. 2016;29:3596–3601. doi: 10.3109/14767058.2016.1143927.
    1. Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372:814–824. doi: 10.1056/NEJMoa1405789.
    1. Dalfrà MG, Busetto L, Chilelli NC, Lapolla A. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. 2012;25:1537–1543. doi: 10.3109/14767058.2012.663829.
    1. Egan AM, Dennedy MC, Al-Ramli W, Heerey A, Avalos G, Dunne F. ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab. 2014;99:212–219. doi: 10.1210/jc.2013-2684.
    1. Simmons D, Devlieger R, van Assche A, et al. Effect of physical activity and/or healthy eating on GDM risk: the DALI lifestyle study. J Clin Endocrinol Metab. 2017;102:903–913.
    1. Oostdam N, van Poppel MN, Wouters MG, van Mechelen W. Interventions for preventing gestational diabetes mellitus: a systematic review and meta-analysis. J Women’s Health. 2011;20:1551–1563. doi: 10.1089/jwh.2010.2703.
    1. Song C, Li J, Leng J, Ma RC, Yang X. Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obes Rev. 2016;17:960–969. doi: 10.1111/obr.12442.
    1. Grotenfelt NE, Wasenius NS, Rono K, et al. Interaction between rs10830963 polymorphism in MTNR1B and lifestyle intervention on occurrence of gestational diabetes. Diabetologia. 2016;59:1655–1658. doi: 10.1007/s00125-016-3989-1.
    1. Syngelaki A, Nicolaides KH, Balani J, et al. Metformin versus placebo in obese pregnant women without diabetes mellitus. N Engl J Med. 2016;374:434–443. doi: 10.1056/NEJMoa1509819.
    1. Farren M, Daly N, McKeating A, Kinsley B, Turner MJ, Daly S. The prevention of gestational diabetes mellitus with antenatal oral inositol supplementation: a randomized controlled trial. Diabetes Care. 2017;40:759–763. doi: 10.2337/dc16-2449.
    1. Agha-Jaffar R, Oliver N, Johnston D, Robinson S. Gestational diabetes mellitus: does an effective prevention strategy exist? Nat Rev Endocrinol. 2016;12:533–546. doi: 10.1038/nrendo.2016.88.
    1. Nitert MD, Barrett HL, Foxcroft K, et al. SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC Pregnancy Childbirth. 2013;13:50. doi: 10.1186/1471-2393-13-50.
    1. Ma RC, Schmidt MI, Tam WH, McIntyre HD, Catalano PM. Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol. 2016;4:1037–1049. doi: 10.1016/S2213-8587(16)30278-9.
    1. Kjos SL, Schaefer-Graf UM. Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care. 2007;30(Suppl 2):S200–S205. doi: 10.2337/dc07-s216.
    1. Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care. 2011;34:1660–1668. doi: 10.2337/dc11-0241.
    1. Rowan JA, Gao W, Hague WM, McIntyre HD. Glycemia and its relationship to outcomes in the metformin in gestational diabetes trial. Diabetes Care. 2010;33:9–16. doi: 10.2337/dc09-1407.
    1. Lindsay RS, Loeken MR. Metformin use in pregnancy: promises and uncertainties. Diabetologia. 2017;60:1612–1619. doi: 10.1007/s00125-017-4351-y.
    1. Eriksson UJ. Congenital anomalies in diabetic pregnancy. Semin Fetal Neonatal Med. 2009;14:85–93. doi: 10.1016/j.siny.2008.11.001.
    1. Zabihi S, Loeken MR. Understanding diabetic teratogenesis: where are we now and where are we going? Birth Defects Res A Clin Mol Teratol. 2010;88:779–790. doi: 10.1002/bdra.20704.
    1. Kang HY, Hong EJ, Kang HS, Ahn C, Jeung EB. Assessment of neurotoxicity of pharmacological compounds during early neural development of human embryonic stem cells. J Physiol Pharmacol. 2017;68:231–241.
    1. Desoye G, Nolan CJ. The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia. 2016;59:1089–1094. doi: 10.1007/s00125-016-3931-6.
    1. Herrera E, Desoye G. Maternal and fetal lipid metabolism under normal and gestational diabetic conditions. Horm Mol Biol Clin Invest. 2016;26:109–127.
    1. Schaefer-Graf UM, Meitzner K, Ortega-Senovilla H, et al. Differences in the implications of maternal lipids on fetal metabolism and growth between gestational diabetes mellitus and control pregnancies. Diabet Med. 2011;28:1053–1059. doi: 10.1111/j.1464-5491.2011.03346.x.
    1. O’Tierney-Ginn P, Presley L, Minium J, Hauguel deMouzon S, Catalano PM. Sex-specific effects of maternal anthropometrics on body composition at birth. Am J Obstet Gynecol. 2014;211(292):e291–e299.
    1. Poulos SP, Dodson MV, Culver MF, Hausman GJ. The increasingly complex regulation of adipocyte differentiation. Exp Biol Med. 2016;241:449–456. doi: 10.1177/1535370215619041.
    1. Jawerbaum A, Capobianco E. Review: effects of PPAR activation in the placenta and the fetus: implications in maternal diabetes. Placenta. 2011;32(Suppl 2):S212–S217. doi: 10.1016/j.placenta.2010.12.002.
    1. Lappas M, Hiden U, Desoye G, Froehlich J, Mouzon SH, Jawerbaum A. The role of oxidative stress in the pathophysiology of gestational diabetes mellitus. Antioxid Redox Signal. 2011;15:3061–3100. doi: 10.1089/ars.2010.3765.
    1. Hughes RC, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c ≥ 5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care. 2014;37:2953–2959. doi: 10.2337/dc14-1312.
    1. Okubo H, Crozier SR, Harvey NC, et al. Maternal dietary glycemic index and glycemic load in early pregnancy are associated with offspring adiposity in childhood: the Southampton Women’s Survey. Am J Clin Nutr. 2014;100:676–683. doi: 10.3945/ajcn.114.084905.
    1. Frohlich JD, Huppertz B, Abuja PM, Konig J, Desoye G. Oxygen modulates the response of first-trimester trophoblasts to hyperglycemia. Am J Pathol. 2012;180:153–164. doi: 10.1016/j.ajpath.2011.09.012.
    1. Effendi M, Demers S, Giguere Y, et al. Association between first-trimester placental volume and birth weight. Placenta. 2014;35:99–102. doi: 10.1016/j.placenta.2013.11.015.
    1. Bonner-Weir S, Aguayo-Mazzucato C, Weir GC. Dynamic development of the pancreas from birth to adulthood. Ups J Med Sci. 2016;121:155–158. doi: 10.3109/03009734.2016.1154906.
    1. Gibson KS, Stetzer B, Catalano PM, Myers SA. Comparison of 2- and 3-dimensional sonography for estimation of birth weight and neonatal adiposity in the setting of suspected fetal macrosomia. J Ultrasound Med. 2016;35:1123–1129. doi: 10.7863/ultra.15.06106.
    1. Malin GL, Bugg GJ, Takwoingi Y, Thornton JG, Jones NW. Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis. BJOG. 2016;123:77–88. doi: 10.1111/1471-0528.13517.
    1. Gonzalez Gonzalez NL, Plasencia W, Gonzalez Davila E, et al. The effect of customized growth charts on the identification of large for gestational age newborns. Eur J Obstet Gynecol Reprod Biol. 2013;26:62–65.
    1. Agarwal MM, Boulvain M, Coetzee E, et al. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014;103:341–363. doi: 10.1016/j.diabres.2013.10.012.
    1. International Association of Diabetes in Pregnancy Groups Consensus Panel International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–682. doi: 10.2337/dc09-1848.
    1. McIntyre HD, Sacks DA, Barbour LA, et al. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care. 2016;39:53–54. doi: 10.2337/dc15-1887.
    1. Damm P, Houshmand-Oeregaard A, Kelstrup L, Lauenborg J, Mathiesen ER, Clausen TD. Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia. 2016;59:1396–1399. doi: 10.1007/s00125-016-3985-5.
    1. Aroda VR, Christophi CA, Edelstein SL, et al. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up. J Clin Endocrinol Metab. 2015;100:1646–1653. doi: 10.1210/jc.2014-3761.
    1. Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38:1964–1974. doi: 10.2337/dc15-1419.
    1. Harjutsalo V, Reunanen A, Tuomilehto J. Differential transmission of type 1 diabetes from diabetic fathers and mothers to their offspring. Diabetes. 2006;55:1517–1524. doi: 10.2337/db05-1296.
    1. Camprubi Robles M, Campoy C, Garcia Fernandez L, Lopez-Pedrosa JM, Rueda R, Martin MJ. Maternal diabetes and cognitive performance in the offspring: a systematic review and meta-analysis. PLoS One. 2015;10:e0142583. doi: 10.1371/journal.pone.0142583.
    1. Brinciotti M, Matricardi M, Colatrella A, Torcia F, Fallucca F, Napoli A. Visual evoked potentials in infants of diabetic mothers: relations to clinical and metabolic status during pregnancy and delivery. Clin Neurophysiol. 2009;120:563–568. doi: 10.1016/j.clinph.2008.12.028.
    1. Hattersley AT, Patel KA. Precision diabetes: learning from monogenic diabetes. Diabetologia. 2017;60:769–777. doi: 10.1007/s00125-017-4226-2.
    1. Houshmand-Oeregaard A, Hansen NS, Hjort L, et al. Differential adipokine DNA methylation and gene expression in subcutaneous adipose tissue from adult offspring of women with diabetes in pregnancy. Clin Epigenetics. 2017;9:37. doi: 10.1186/s13148-017-0338-2.
    1. Kim H, Toyofuku Y, Lynn FC, et al. Serotonin regulates pancreatic beta cell mass during pregnancy. Nat Med. 2010;16:804–808. doi: 10.1038/nm.2173.
    1. Horn S, Kirkegaard JS, Hoelper S, et al. Research resource: a dual proteomic approach identifies regulated islet proteins during β-cell mass expansion in vivo. Mol Endocrinol. 2016;30:133–143. doi: 10.1210/me.2015-1208.
    1. Allalou A, Nalla A, Prentice KJ, et al. A predictive metabolic signature for the transition from gestational diabetes mellitus to type 2 diabetes. Diabetes. 2016;65:2529–2539. doi: 10.2337/db15-1720.

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