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Women who had type 1, insulin-dependent diabetes were once advised not even to try to have babies.

Uncontrolled Type 1 Diabetes a Major Cause of Pregnancy Complications

Even as recently as 2009, diabetic women in Sweden were:

•    Three times more likely to have a stillbirth,
•    Three times more likely to deliver a "very preterm" baby, at less than 32 weeks,
•    Two-and-one-half to ten times more likely to have a baby with birth defects, and
•    Eleven times more likely to deliver a very large baby, weighing from 8 to 18 pounds (3.2 to 7.5 kilos).

These are the statistics for women with type 1 diabetes in a modern country with a high standard of prenatal care. Diabetic women who do not have access to good care while they are pregnant are at even greater risk of health problems for their children and themselves.

The key to delivering a healthy child is for diabetic mothers to keep their blood sugar levels nearly normal 24/7. Since the mother is literally "eating for two," it is very hard to keep blood sugar levels down while eating more.

The problem with injected insulin is that even "fast" insulin is not as fast as the insulin produced in a non-diabetic body, so even tiny amounts of additional food can cause blood sugar levels to soar. And using additional insulin to bring blood sugar levels back down to normal when they go too high comes with the risk of using too much. Insulin-induced hypoglycemia, low blood sugar levels that can cause loss of mental acuity and lead to accidents, can be just as problematic as high.

Saving a Pregnancy with an Artificial Pancreas

To help pregnant women from having to risk low blood sugar levels by using large amounts of insulin to cover eating large amounts of food, British physicians have developed a "closed loop insulin delivery system," also known as an artificial pancreas. The artificial pancreas comes with sensors that continuously monitor blood glucose levels. It releases just enough insulin to keep sugar levels in the normal range, just when it is needed.

The greatest advantage of the artificial pancreas is keeping blood sugar levels from falling too low at night. Diabetics use a slower-acting form of insulin to keep blood sugar levels normal at night so they do not have to get up in the middle of the night to take shots.

The problem with using a slower-acting insulin during pregnancy is that the growing fetus may demand an unusually large amount of energy, and blood sugar levels can fall dangerously low. To avoid this problem, a woman might take less of the slower-acting insulin at night before going to bed, but then there is a risk of blood sugar levels going too high.

The artificial pancreas uses only fast-acting insulin, and only enough to manage blood sugar levels through the night. Dr. Helen Murphy of Cambridge University led the study involving 10 pregnant women with type 1 diabetes, and reported that the device prevented dangerous swings in blood sugar levels throughout pregnancy. Larger-scale studies will be needed to confirm that use of the device prevents birth defects, high-weight babies, premature delivery, and stillbirths.

  • Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care. 2009 Nov, 32(11):2005-9. Epub 2009 Aug 12
  • Photo courtesy of Greg Grossmeier by Flickr :