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Open Access 01-05-2018 | Review

Diabetes in pregnancy: a new decade of challenges ahead

Authors: Ute Schaefer-Graf, Angela Napoli, Christopher J. Nolan, the Diabetic Pregnancy Study Group

Published in: Diabetologia | Issue 5/2018

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.

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Colstrup M, Mathiesen ER, Damm P, Jensen DM, Ringholm L (2013) 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 26:1682–1686CrossRefPubMed

Macintosh MC, Fleming KM, Bailey JA et al (2006) 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 333:177CrossRefPubMedPubMedCentral

Murphy HR, Bell R, Cartwright C et al (2017) Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia 60:1668–1677CrossRefPubMedPubMedCentral

Wahabi HA, Alzeidan RA, Esmaeil SA (2012) Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health 12:792CrossRefPubMedPubMedCentral

Scheffler RM, Feuchtbaum LB, Phibbs CS (1992) Prevention: the cost-effectiveness of the California Diabetes and Pregnancy Program. Am J Public Health 82:168–175CrossRefPubMedPubMedCentral

NHS Digital (2016) National Diabetes in Pregnancy Audit. Available from http://content.digital.nhs.uk/npid. Accessed 16 Oct 2017

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

Egan AM, Galjaard S, Maresh MJA et al (2017) A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes. Diabetologia 60:1190–1196CrossRefPubMedPubMedCentral

Maresh MJ, Holmes VA, Patterson CC et al (2015) Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes. Diabetes Care 38:34–42CrossRefPubMed

10.

Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER (2013) The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care 36:1877–1883CrossRefPubMedPubMedCentral

11.

American Diabetes Association (2017) Management of diabetes in pregnancy. Diabetes Care 40:S114–S119CrossRef

12.

National Institute for Health and Care Excellence (NICE) (2015). Diabetes in pregnancy: management from preconception to the postnatal period. Available from nice.org.uk/guidance/ng3. Accessed 16 Oct 2017

13.

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

14.

Feig DS, Donovan LE, Corcoy R et al (2017) Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 390:2347–2359CrossRefPubMedPubMedCentral

15.

Stewart ZA, Wilinska ME, Hartnell S et al (2016) Closed-loop insulin delivery during pregnancy in women with type 1 diabetes. N Engl J Med 375:644–654CrossRefPubMed

16.

Fresa R, Visalli N, Di Blasi V et al (2013) 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 15:328–334CrossRefPubMed

17.

Ringholm L, Mathiesen ER, Kelstrup L, Damm P (2012) Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding. Nat Rev Endocrinol 8:659–667CrossRefPubMed

18.

Bell R, Glinianaia SV, Tennant PW, Bilous RW, Rankin J (2012) Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia 55:936–947CrossRef

19.

Zeisler H, Llurba E, Chantraine F et al (2016) Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med 374:13–22CrossRefPubMed

20.

Concillado M, Lund-Andersen H, Mathiesen ER, Larsen M (2016) Dexamethasone intravitreal implant for diabetic macular edema during pregnancy. Am J Ophthalmol 165:7–15CrossRefPubMed

21.

Poston L, Caleyachetty R, Cnattingius S et al (2016) Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol 4:1025–1036CrossRefPubMed

22.

Catalano PM, Mele L, Landon MB et al (2014) Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth? Am J Obstet Gynecol 211:137 e131-137CrossRef

23.

Hinkle SN, Sharma AJ, Dietz PM (2010) Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr 92:644–651CrossRefPubMed

24.

Abenhaim HA, Alrowaily N, Czuzoj-Shulman N, Spence AR, Klam SL (2016) Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women. J Matern Fetal Neonatal Med 29:3596–3601CrossRefPubMed

25.

Johansson K, Cnattingius S, Naslund I et al (2015) Outcomes of pregnancy after bariatric surgery. N Engl J Med 372:814–824CrossRefPubMed

26.

Dalfrà MG, Busetto L, Chilelli NC, Lapolla A (2012) Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med 25:1537–1543CrossRefPubMed

27.

Egan AM, Dennedy MC, Al-Ramli W, Heerey A, Avalos G, Dunne F (2014) ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab 99:212–219CrossRefPubMed

28.

Simmons D, Devlieger R, van Assche A et al (2017) Effect of physical activity and/or healthy eating on GDM risk: the DALI lifestyle study. J Clin Endocrinol Metab 102:903–913PubMed

29.

Oostdam N, van Poppel MN, Wouters MG, van Mechelen W (2011) Interventions for preventing gestational diabetes mellitus: a systematic review and meta-analysis. J Women’s Health 20:1551–1563CrossRef

30.

Song C, Li J, Leng J, Ma RC, Yang X (2016) Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obes Rev 17:960–969CrossRefPubMed

31.

Grotenfelt NE, Wasenius NS, Rono K et al (2016) Interaction between rs10830963 polymorphism in MTNR1B and lifestyle intervention on occurrence of gestational diabetes. Diabetologia 59:1655–1658CrossRefPubMed

32.

Syngelaki A, Nicolaides KH, Balani J et al (2016) Metformin versus placebo in obese pregnant women without diabetes mellitus. N Engl J Med 374:434–443CrossRefPubMed

33.

Farren M, Daly N, McKeating A, Kinsley B, Turner MJ, Daly S (2017) The prevention of gestational diabetes mellitus with antenatal oral inositol supplementation: a randomized controlled trial. Diabetes Care 40:759–763CrossRefPubMed

34.

Agha-Jaffar R, Oliver N, Johnston D, Robinson S (2016) Gestational diabetes mellitus: does an effective prevention strategy exist? Nat Rev Endocrinol 12:533–546CrossRefPubMed

35.

Nitert MD, Barrett HL, Foxcroft K et al (2013) SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC Pregnancy Childbirth 13:50CrossRefPubMedPubMedCentral

36.

Ma RC, Schmidt MI, Tam WH, McIntyre HD, Catalano PM (2016) Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol 4:1037–1049CrossRefPubMed

37.

Kjos SL, Schaefer-Graf UM (2007) 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 30(Suppl 2):S200–S205CrossRefPubMed

38.

Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA (2011) Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care 34:1660–1668CrossRefPubMedPubMedCentral

39.

Rowan JA, Gao W, Hague WM, McIntyre HD (2010) Glycemia and its relationship to outcomes in the metformin in gestational diabetes trial. Diabetes Care 33:9–16CrossRefPubMed

40.

Lindsay RS, Loeken MR (2017) Metformin use in pregnancy: promises and uncertainties. Diabetologia 60:1612–1619CrossRefPubMedPubMedCentral

41.

Eriksson UJ (2009) Congenital anomalies in diabetic pregnancy. Semin Fetal Neonatal Med 14:85–93CrossRefPubMed

42.

Zabihi S, Loeken MR (2010) Understanding diabetic teratogenesis: where are we now and where are we going? Birth Defects Res A Clin Mol Teratol 88:779–790CrossRefPubMedPubMedCentral

43.

Kang HY, Hong EJ, Kang HS, Ahn C, Jeung EB (2017) Assessment of neurotoxicity of pharmacological compounds during early neural development of human embryonic stem cells. J Physiol Pharmacol 68:231–241PubMed

44.

Desoye G, Nolan CJ (2016) The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia 59:1089–1094CrossRefPubMedPubMedCentral

45.

Herrera E, Desoye G (2016) Maternal and fetal lipid metabolism under normal and gestational diabetic conditions. Horm Mol Biol Clin Invest 26:109–127

46.

Schaefer-Graf UM, Meitzner K, Ortega-Senovilla H et al (2011) Differences in the implications of maternal lipids on fetal metabolism and growth between gestational diabetes mellitus and control pregnancies. Diabet Med 28:1053–1059CrossRefPubMed

47.

O’Tierney-Ginn P, Presley L, Minium J, Hauguel deMouzon S, Catalano PM (2014) Sex-specific effects of maternal anthropometrics on body composition at birth. Am J Obstet Gynecol 211(292):e291–e299

48.

Poulos SP, Dodson MV, Culver MF, Hausman GJ (2016) The increasingly complex regulation of adipocyte differentiation. Exp Biol Med 241:449–456CrossRef

49.

Jawerbaum A, Capobianco E (2011) Review: effects of PPAR activation in the placenta and the fetus: implications in maternal diabetes. Placenta 32(Suppl 2):S212–S217CrossRefPubMed

50.

Lappas M, Hiden U, Desoye G, Froehlich J, Mouzon SH, Jawerbaum A (2011) The role of oxidative stress in the pathophysiology of gestational diabetes mellitus. Antioxid Redox Signal 15:3061–3100CrossRefPubMed

51.

Hughes RC, Moore MP, Gullam JE, Mohamed K, Rowan J (2014) 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 37:2953–2959CrossRefPubMed

52.

Okubo H, Crozier SR, Harvey NC et al (2014) 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 100:676–683CrossRefPubMed

53.

Frohlich JD, Huppertz B, Abuja PM, Konig J, Desoye G (2012) Oxygen modulates the response of first-trimester trophoblasts to hyperglycemia. Am J Pathol 180:153–164CrossRefPubMed

54.

Effendi M, Demers S, Giguere Y et al (2014) Association between first-trimester placental volume and birth weight. Placenta 35:99–102CrossRefPubMed

55.

Bonner-Weir S, Aguayo-Mazzucato C, Weir GC (2016) Dynamic development of the pancreas from birth to adulthood. Ups J Med Sci 121:155–158CrossRefPubMedPubMedCentral

56.

Gibson KS, Stetzer B, Catalano PM, Myers SA (2016) 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 35:1123–1129CrossRefPubMed

57.

Malin GL, Bugg GJ, Takwoingi Y, Thornton JG, Jones NW (2016) Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis. BJOG 123:77–88CrossRefPubMed

58.

Gonzalez Gonzalez NL, Plasencia W, Gonzalez Davila E et al (2013) The effect of customized growth charts on the identification of large for gestational age newborns. Eur J Obstet Gynecol Reprod Biol 26:62–65

59.

Agarwal MM, Boulvain M, Coetzee E et al (2014) Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract 103:341–363CrossRef

60.

International Association of Diabetes in Pregnancy Groups Consensus Panel (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682CrossRef

61.

McIntyre HD, Sacks DA, Barbour LA et al (2016) Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care 39:53–54CrossRefPubMed

62.

Damm P, Houshmand-Oeregaard A, Kelstrup L, Lauenborg J, Mathiesen ER, Clausen TD (2016) Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia 59:1396–1399CrossRefPubMed

63.

Aroda VR, Christophi CA, Edelstein SL et al (2015) 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 100:1646–1653CrossRefPubMedPubMedCentral

64.

Insel RA, Dunne JL, Atkinson MA et al (2015) Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care 38:1964–1974CrossRefPubMedPubMedCentral

65.

Harjutsalo V, Reunanen A, Tuomilehto J (2006) Differential transmission of type 1 diabetes from diabetic fathers and mothers to their offspring. Diabetes 55:1517–1524CrossRefPubMed

66.

Camprubi Robles M, Campoy C, Garcia Fernandez L, Lopez-Pedrosa JM, Rueda R, Martin MJ (2015) Maternal diabetes and cognitive performance in the offspring: a systematic review and meta-analysis. PLoS One 10:e0142583CrossRefPubMedPubMedCentral

67.

Brinciotti M, Matricardi M, Colatrella A, Torcia F, Fallucca F, Napoli A (2009) Visual evoked potentials in infants of diabetic mothers: relations to clinical and metabolic status during pregnancy and delivery. Clin Neurophysiol 120:563–568CrossRefPubMed

68.

Hattersley AT, Patel KA (2017) Precision diabetes: learning from monogenic diabetes. Diabetologia 60:769–777CrossRefPubMed

69.

Houshmand-Oeregaard A, Hansen NS, Hjort L et al (2017) Differential adipokine DNA methylation and gene expression in subcutaneous adipose tissue from adult offspring of women with diabetes in pregnancy. Clin Epigenetics 9:37CrossRefPubMedPubMedCentral

70.

Kim H, Toyofuku Y, Lynn FC et al (2010) Serotonin regulates pancreatic beta cell mass during pregnancy. Nat Med 16:804–808CrossRefPubMedPubMedCentral

71.

Horn S, Kirkegaard JS, Hoelper S et al (2016) Research resource: a dual proteomic approach identifies regulated islet proteins during β-cell mass expansion in vivo. Mol Endocrinol 30:133–143CrossRefPubMed

72.

Allalou A, Nalla A, Prentice KJ et al (2016) A predictive metabolic signature for the transition from gestational diabetes mellitus to type 2 diabetes. Diabetes 65:2529–2539CrossRefPubMedPubMedCentral

Title: Diabetes in pregnancy: a new decade of challenges ahead
Authors: Ute Schaefer-Graf
Angela Napoli
Christopher J. Nolan
the Diabetic Pregnancy Study Group
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Diabetologia / Issue 5/2018
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-018-4545-y

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