NUI Galway Research into Diabetes and Pregnancy Enters Final Phase

Friday, 22 May 2009

A study at NUI Galway into diabetes among pregnant Irish women has entered its final phase with further funding from the Health Research Board. Diabetes is the most prevalent chronic medical condition among pregnant women, with international estimates that it occurs in 2-9% of all pregnancies. The research at NUI Galway is the first prospective study to look at the prevalence and effects of diabetes among pregnant women in Ireland, working with over 10,000 women. The Atlantic Diabetes in Pregnancy (Atlantic Dip) research programme has been underway for three years and this further funding will support two final years of research. The study is led by Professor Fidelma Dunne, Head of the School of Medicine at NUI Galway, and also Consultant Endocrinologist with Galway University Hospitals. According to Professor Dunne: "Diabetes can be a serious problem for pregnant women. The outcomes for the mother and infant are less satisfactory when compared with the non-diabetic population. There is an increase in the risk of congenital malformations, stillbirths and neonatal deaths in the offspring. In addition these babies may require care in a neonatal unit because of respiratory and other problems. For the mother there is an increase in the risk of blood pressure and pre-eclampsia and they are more likely to be delivered by caesarian section". Professor Dunne added: "Babies from mothers with diabetes are at increased risk of weighing greater than 4 kg at birth. This in itself increases the risk of obesity and diabetes in their adult lives. Among women who already had diabetes before pregnancy, the study has found that women are poorly prepared for pregnancy with only 28% receiving pre-pregnancy care, 43% having folic acid and 29% achieving good sugar control levels". In addition to what is commonly known as type one and two diabetes, pregnant women can also develop Gestational Diabetes Mellitus (GDM), diabetes occurring after 20 weeks of pregnancy. GDM is also associated with increased risks for the mother and her infant in the current pregnancy. It is associated with a very high life time risk of type two diabetes in the mother. Working with over 10,000 women along the Irish Atlantic seaboard, the Atlantic Diabetes in Pregnancy (Atlantic Dip) research programme has offered screening for GDM to all pregnant women to establish how many developed Gestational Diabetes (GDM) and its less severe form of impaired glucose tolerance (IGT). Of the 4,000 women tested, 130 (3.3%) had GDM and 328 (8%) had IGT. In addition, 50% of the cohort had a body mass index (BMI) in the overweight and obese categories. Professor Dunne says the data generated to date would suggest that universal screening for GDM and IGT should be offered to all pregnant women in Ireland: "Considering the high prevalence of GDM and IGT in the Irish population, a national screening programme should be considered. This would allow the identification of an 'at risk' population where intervention is likely to impact on the health of the infant from the pregnancy in addition to the future health of the mother and offspring". Professor Dunne and her team have also examined the impact of obesity alone on the outcome of pregnancy in 1,441 women in whom all forms of diabetes was excluded. They showed that obesity was an independent risk factor for higher rates of caesarian section, blood pressure, miscarriage, and babies weighing more than 4kg at birth. Professor Dunne says: "Obesity in women of reproductive age is thus a public health concern and requires intervention. Maternal obesity with or without diabetes will impact on the health of future generations". The next two years of this study will build on existing data and will provide greater insight into the prevalence and consequences of GDM and IGT in the Irish population. In particular it will examine the risk of persistent diabetes following GDM and IGT and the factors that increase this risk. Through collaborative work with UK-based Peninsula Medical School the project will explore the genetics behind GDM. There are also plans to develop and test an intervention programme for pre-pregnancy care for women with diabetes to see if the rates of stillbirth neonatal death and congenital malformation rates can be reduced.
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