Type 1 Diabetes Mellitus Women Research Articles

Attitudes towards preconception care in Maltese women with type 1 diabetes mellitus

Introduction: The aim of this study was to assess the level of knowledge and awareness related to preconception care among Maltese women of reproductive age with type 1 diabetes mellitus (T1DM). Methods: Thirty-seven T1DM women, aged 12–30 years, were self-administered a questionnaire related to diabetes self-management and preconception care. The participants then underwent an educational intervention and re-took the same questionnaire. Results: Before the intervention, 26 participants (70%) claimed they did not have any knowledge about the preconception care of diabetes. Of the remaining 11 participants, the main reported source of information about diabetes care was the diabetologist (n = 8; 6.7%). The response rate was 70% (26 out of 37 participants completed the questionnaire after the educational intervention). Six of the participants who initially reported no preconception care knowledge claimed an increased awareness after the event. There was a statistically significant increase in the knowledge scores after the intervention. Conclusion: It is evident that there is a lack of awareness of the importance of pre-pregnancy planning to avoid pregnancy-related complications with diabetes. This emphasizes the need for more education and it is imperative for healthcare professionals to address these issues with adolescent female patients.

Plasma Lipoproteins and Preeclampsia in Women with Type 1 Diabetes: A Prospective Study

In nondiabetic pregnancy, cross-sectional studies have shown associations between maternal dyslipidemia and preeclampsia (PE). In type 1 diabetes mellitus (T1DM), the prevalence of PE is increased 4-fold, but prospective associations with plasma lipoproteins are unknown. The aim of this study was to define lipoprotein-related markers and potential mechanisms for PE in T1DM. We conducted a multicenter prospective study in T1DM pregnancy. We studied 118 T1DM women (26 developed PE, 92 remained normotensive). Subjects were studied at three visits before PE onset [12.2 ± 1.9, 21.6 ± 1.5, and 31.5 ± 1.7 wk gestation (means ± SD)] and at term (37.6 ± 2.0 wk). Nondiabetic normotensive pregnant women (n = 21) were included for reference. Conventional lipid profiles, lipoprotein subclasses [defined by size (nuclear magnetic resonance) and by apolipoprotein content], serum apolipoproteins (ApoAI, ApoB, and ApoCIII), and lipolysis (ApoCIII ratio) were measured in T1DM women with and without subsequent PE. In women with vs. without subsequent PE, at the first and/or second study visits: low-density lipoprotein (LDL)-cholesterol, particle concentrations of total LDL and large (but not small) LDL, serum ApoB, and ApoB:ApoAI ratio were all increased (P < 0.05); peripheral lipoprotein lipolysis was decreased (P < 0.01). These early differences remained significant in covariate analysis (glycated hemoglobin, actual prandial status, gravidity, body mass index, and diabetes duration) but were not present at the third study visit. High-density lipoprotein and very low-density lipoprotein subclasses did not differ between groups before PE onset. Early in pregnancy, increased cholesterol-rich lipoproteins and an index suggesting decreased peripheral lipolysis were associated with subsequent PE in T1DM women. Background maternal lipoprotein characteristics, perhaps masked by effects of late pregnancy, may influence PE risk.

Impact of type 1 diabetes and glycemic control on fetal aneuploidy biochemical markers

To determine the influence of type 1 diabetes mellitus (T1DM) on the first trimester serum markers of fetal aneuploidy; pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free β-hCG) and to evaluate the influence of glycemic control on these parameters in the pregnant diabetic women. Retrospective study. Data were extracted from electronic obstetric and laboratory databases at two Danish University Hospitals. Based on 36 415 pregnancies without T1DM (non-T1DM) and 331 pregnancies with T1DM; β-hCG and PAPP-A were obtained at 8+0 to 14+2 gestational weeks. Medians for PAPP-A and free β-hCG were generated and multiple of the normal gestation-specific median (MoM) values were calculated for each separate pregnancy. After adjustment for maternal weight, ethnicity and smoking status, MoM values were compared across the T1DM and non-T1DM groups, respectively. Additionally, the relationship between PAPP-A MoM and HgbA1C was examined in 348 T1DM pregnancies by Spearman's rank correlation. MAIN OUTCOME MEASURES. Difference in biochemical marker levels between T1DM and non-T1DM. PAPP-A was 0.86 MoM in T1DM pregnancies and 1.01 MoM in non-T1DM pregnancies, p < 0.0001. Conversely, free β-hCG was not altered in T1DM pregnancies (T1DM 0.99 MoM, non-T1DM 0.98 MoM; p=0.14). There was a significant inverse correlation between HgbA1C and PAPP-A (rho=-0.12, p=0.02). In T1DM pregnancies, PAPP-A MoM values were lower than in non-T1DM pregnancies. This suggests that correction should be considered in first trimester biochemical screening for fetal aneuploidy in T1DM women.

Quality of life in pregnancy and post-partum: a study in diabetic patients

We evaluated quality of life in pregnant women with diabetes followed up at Italian diabetes clinics. A total of 245 pregnant women (30 type 1 diabetes mellitus (T1DM), 176 gestational diabetes (GDM) and 39 controls) were asked to fill in a questionnaire including the SF-36 Health Survey and the Center for Epidemiological Studies-Depression (CES-D) Scale in third trimester of pregnancy and after delivery. GDM and T1DM also completed two diabetes-specific questionnaires (Diabetes-related stress and Diabetes health distress). Quality of life scores were compared between the groups with the Mann-Whitney U-test, mean changes in scores (after delivery to 3rd trimester) were compared between groups by ANCOVA. Regarding the SF-36 scores in the third trimester of pregnancy, T1DM and GDM women had a better Standardised Physical Component score than controls (P<0.0001, P=0.009, respectively). GDM and T1DM pregnant women scored significantly lower for general health perception than controls (P=0.009 and P=0.001, respectively). T1DM patients had lower Standardised Mental Component scores than controls (P=0.03). Compared with the third trimester of pregnancy, the severity of depressive symptoms increased significantly after delivery in both diabetic groups, but not in controls (P<0.0001). Scores improved in all SF-36 areas in healthy and GDM women, while they all became worse in the T1DM group. Pregnancy is associated with a perception of poor general health in women with both T1DM and GDM. After delivery, significantly worse depressive symptoms were documented in both groups, while a generally worse physical and psychological well-being was only identified in women with T1DM. These findings have important implications for pregnancy follow-up.

Glycemic Control and Perinatal Outcomes of Pregnancies Complicated by Type 1 Diabetes: Influence of Continuous Subcutaneous Insulin Infusion and Lispro Insulin

This study compared glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes mellitus (T1DM) treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) using regular (RI) or lispro (LP) insulin. Three hundred fifteen consecutive singleton pregnancies of T1DM women using the same insulin program since before pregnancy (196 MDI with NPH + RI, 16 MDI with NPH + LP, 44 CSII with RI, 59 CSII with LP) were studied. Variables of glycemic control assessed included glycated hemoglobin, mean blood glucose (MBG), and insulin doses in each trimester, diabetic ketoacidosis, and hypoglycemic comas. Variables of pregnancy outcome included miscarriage, preterm birth, large or small for gestational age (LGA or SGA, respectively) newborns, and perinatal mortality. Multiple linear regression and logistic regression analysis were used. Groups differed in baseline and glycemic control but not in maternal or fetal outcomes. In multivariate analysis, LP was associated with higher second trimester MBG and lower rate of hypoglycemic coma, CSII with higher third trimester MBG, and CSII + LP with lower insulin requirements and lower rate of hypoglycemic coma. As to pregnancy outcomes, LP was associated with lower risk of preterm birth and higher risk of SGA, CSII with lower risk of SGA and higher risk of LGA and perinatal mortality, and CSII + LP with higher risk of miscarriage. Pregnant women with T1DM using LP and/or CSII had different characteristics. LP with or without CSII was independently associated with fewer hypoglycemic comas, whereas impact of LP/CSII on the fetus had a favorable or an unfavorable influence depending on the specific outcome.

Glycemic Control and Selected Pregnancy Outcomes in Type 1 Diabetes Women on Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: The Significance of Pregnancy Planning

Two regimens are used to achieve excellent glycemic control during pregnancy in type 1 diabetes mellitus (T1DM): continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI). We assessed their efficacy and safety and the effect of pregnancy planning. We examined 269 pregnant T1DM women: 157 treated with MDI (MDI group), 42 with CSII (CSII group), and 70 who switched from MDI to CSII in the first trimester (MDI/CSII group). There were 116 women who planned pregnancy: 58 in the MDI group, 38 in the CSII group, and 20 in the MDI/CSII group. The estimated differences in glycemic control and maternal and fetal outcomes were adjusted for baseline characteristics. Mean glycated A1c (HbA1c) in the first trimester in the whole group was 6.9%, and the women differed depending on whether they planned pregnancy or not (P < 0.0001). A multiple regression model showed an average difference of about 0.9% in favor of pregnancy planning, with no interaction between the planning and treatments. In the second trimester, HbA1c decreased to a mean value of 5.8%, with improvement of HbA1c across all treatments: by 1.5% in not-planning and 0.9% in planning women. Despite greater improvement, not-planning women still had a higher HbA1c (by 0.3%, P = 0.05). In the third trimester, there was no further significant changes; nevertheless, women who planned pregnancy still had a lower HbA1c (by 0.5%, P = 0.02). There were 14 malformations, stillbirths, and perinatal infant deaths in the not-planning versus five in the planning group (P = 0.07). Patients in the CSII group had a 2 kg greater weight gain compared to the MDI group (15.0 kg vs. 13.0 kg; P = 0.005). In pregnancy with T1DM, both MDI and CSII can provide excellent glycemic control. Pregnancy planning has a beneficial effect on glycemic control, independent from the therapy model. CSII seems to predispose to a larger weight gain in mothers.

Bone mass and sex steroids in postmenarcheal adolescents and adult women with Type 1 diabetes mellitus

Objective The aim of this study was to compare the bone mass in young adolescents and adult women with Type 1 diabetes mellitus (T1DM) and determine its relationship with sex steroid and sex hormone-binding globulin (SHBG) levels. Design Cross-sectional study. Patients We studied a group of adolescents and adult women with T1DM ( n=45) and 50 healthy controls (C) matched by gynecological age and body mass index in a case-control study. Girls with menarche within the last 18–40 months ( n=17 T1DM and 32 C) and adult women (age=30.4+1.4 years; n=28 T1DM and 18 C) were recruited. Measurements Bone mass was evaluated with a GE Lunar Prodigy densitometer. Sex steroid levels were measured by radioimmunoassay. Results Bone mass was lower in adolescents with T1DM than in control adolescents, but was similar in both groups of postmenarcheal girls after adjusting for age, lean, and fat mass. However, adult T1DM women exhibited lower adjusted and unadjusted ( P<.05) Z-femoral neck (−0.2±0.2 vs. 0.4±0.2) and bone mineral content (BMC) (2306±61 vs. 2645±79 g) than adult controls. Adult controls and T1DM adults showed higher whole body BMC than adolescent controls and T1DM adolescents, respectively. Bone mass in T1DM did not correlate with estradiol, free estradiol, testosterone, SHBG, or HbA1c levels. Conclusions The diminished bone mass observed in adult T1DM women does not appear to be related to sex steroid levels. In young adolescents with T1DM, the observed decrease in bone mass appears to be related to differences in body composition and age.

Night/day ratio as predictor of preeclampsia in normoalbuminuric, diabetic women: early signs of blood pressure disorders

Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type 1 diabetes mellitus (T1DM) and in non-diabetic women was evaluated for its association with preeclampsia, retinopathy, HbA1c, and birth weight. One hundred and sixty-one women were recruited for AMBP performed with a Spacelab 90207 monitor. The pregnant women were 50 non-diabetic women and 111 T1DM women with normoalbuminuria and no hypertension. ANOVA, regression, and ROC curves analysis were applied. Women with simplex retinopathy had higher night/day ratio and lower birth weight than those without retinopathy. Women who developed preeclampsia had night/day ratio similar to those with simplex retinopathy. In first trimester they had higher blood pressure than those who did not develop preeclampsia. Simplex retinopathy and preeclampsia are associated with a reduced night/day ratio even with normal blood pressure but night/day ratio provides no better prediction of preeclampsia than the absolute values.

Ultrasonic Morphological Characteristics of Yolk Sac in Pregnancy Complicated with Type-1 Diabetes mellitus

Background/Aims: In pregnancy complicated with type-1 diabetes mellitus (DM), information on the predictive value of yolk sac (YS) measurement and YS morphology on outcome has been scant. The aim of this study was to compare the size and shape of the YS using transvaginal sonography (TVS) in normal pregnancies and those complicated with well-regulated type-1 DM. Methods: Sixty healthy pregnant women and 60 pregnant women with type-1 DM underwent TVS. The correlation coefficients between YS and gestational age (GA), YS and crown-rump length (CRL), and YS and human chorionic gonadotropin (HCG) were calculated. Statistical analysis showed that the difference between the YS diameters for each gestational week among the groups studied was highly statistically significant. Statistical analysis of the results was performed with SPSS 10 software. Results: A highly statistically positive correlation was found between YS diameter and GA, CRL and HCG levels for both groups studied. The YS diameter in type-1 DM pregnancies was statistically significantly larger for GA than that of healthy pregnant women. The YS diameter in type-1 DM women was statistically significantly larger after 6 weeks of gestation and the HbA1c levels were >6% when compared to the YS dimensions in the group with HbA1c concentrations of <6%. Conclusion:A gross change in YS size may indicate or reflect significant dysfunction of the maternofetal transport system in early pregnancy which is complicated with type-1 DM.

The hypothalamus–pituitary–ovary axis and type 1 diabetes mellitus: a mini review

A high prevalence of menstrual cycle and fertility disturbances has long been associated with diabetes mellitus. However, rationalization of the intrinsic mechanisms of these alterations is controversial and even contradictory. This review considers (i) the relationship between diabetes mellitus, especially type 1 diabetes mellitus (T1DM), and the hypothalamus-pituitary-ovary (HPO) axis, (ii) the state of our knowledge concerning neuroendocrine control and its relationship with dopaminergic and opioid tonus, and (iii) the influence of the hypothalamus-pituitary-adrenal axis on ovarian function. Functional disturbances that occur as a consequence of diabetes are also discussed, but some T1DM-related diseases of autoimmune origin, such as oophoritis, are not further analysed. Although there are clear indications of a relationship between menstrual and fertility alterations and glycaemic control, in many instances the improvement of the latter is not sufficient to reverse such alterations. It appears that the oligoamenorrhoea and amenorrhoea associated with T1DM is mainly of hypothalamic origin (i.e. failure of the GnRH pulse generator) and may be reversible. The importance of the evaluation of the HPO axis in T1DM women with menstrual irregularities, even in the presence of adequate metabolic control, is emphasized.