Study: Artificial Pancreas makes Pregnancy Safer for Women with Type 1 Diabetes

By Nicky BroydWebMD Health News

Reviewed by Rob Hicks, MD

Jan. 31, 2011 — for the first time, research has successfully demonstrated the potential benefits of an artificial pancreas in pregnant women with type 1 diabetes. It’s hoped the development, funded by Diabetes UK, could drastically reduce cases of stillbirth and mortality rates among pregnant women with the condition.

Pregnancy and Diabetes

Pregnancy poses additional risks for women with diabetes as hormonal changes make it very difficult to keep blood glucose levels within a safe range, especially at night. As a result of high blood glucose levels, babies of women with diabetes are five times as likely to be stillborn, three times as likely to die in their first months of life, and twice as likely to have a major deformity.

Hypoglycemia (low blood sugar) in pregnancy is a major cause of maternal mortality.

Strict glycemic control is more readily achievable by pregnant women with type 2 diabetes. however, researchers say there has been a disappointing lack of progress in managing type 1 diabetes in pregnancy.

Around 18.8 million people in the U.S. have been diagnosed with diabetes. The CDC says type 1 diabetes accounts for about 5% of adult cases of diabetes.

Artificial Pancreas

The pancreas produces insulin, the hormone that helps to control blood sugar levels. for this latest study, led by Helen Murphy, MD, of Cambridge University, the performance of an artificial pancreas or “closed-loop insulin delivery system” was evaluated in 10 pregnant women with type 1 diabetes. The researchers found the device was able to automatically provide the right amount of insulin at the right time, maintain near-normal blood glucose levels, and, in turn, prevent nocturnal hypoglycemia in both early and late pregnancy.

The artificial pancreas was created by combining a continuous glucose monitor (CGM) with an insulin pump, both of which are already used separately by many people with type 1 diabetes.

An insulin pump removes the need for a series of daily insulin injections. however, people with diabetes still have to test their blood glucose levels frequently and calculate the amount of insulin to take. in comparison, the “artificial pancreas” takes minute-by-minute glucose readings from interstitial fluid using a continuous glucose monitor. The signal will then be transmitted wirelessly to a handheld computer, which calculates the amount of insulin needed. That information is then sent to an insulin pump, which delivers the insulin.

Previous studies have shown improved blood glucose control and reduced hypoglycemia with overnight use of an artificial pancreas in children with type 1 diabetes, but this is the first time it has been successfully used in pregnant women with the condition.

“For women with type 1 diabetes, self-management is particularly challenging during pregnancy due to physiological and hormonal changes. Previous studies indicate that pregnant women with the condition spend an average of ten hours a day with glucose levels outside the recommended target,” Murphy says in a statement.

“These high blood glucose levels increase the risk of congenital malformation, stillbirth, neonatal death, preterm delivery, macrosomia [oversized babies], and neonatal admission. So to discover an artificial pancreas can help maintain near-normal glucose levels in these women is very promising,” she says.

Early Days

Diabetes UK Director of Research Iain Frame, MD, says in a news release, “Although early days, this exciting area of research, funded by our donors, has huge potential to make pregnancy much safer for women with type 1 diabetes, and their babies.

“It’s a fantastic example of how existing technologies, in this case, insulin pumps and CGMs, can be adapted and developed to benefit as many people with diabetes as possible. We now need to see an extension of this study, one which tests larger numbers of women, and then take it out of the hospital and in to the home setting.”

If all goes well and funding is in place, Diabetes UK says the artificial pancreas for pregnant women could be available within five to 10 years.

SOURCES: Diabetes UK.Diabetes Care, manuscript received ahead of print.NHS Choices: “Diabetes Type 1.”CDC.©2011 WebMD, LLC. all Rights Reserved.

The depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child, according to a study led by University of Rochester Medical Center researchers and published online today by the British Journal of Psychiatry.

“Our study clearly shows that the birth of a healthy baby does not resolve the mental health problems that many women experience after a miscarriage or stillbirth,” said Emma Robertson Blackmore, Ph.D., assistant professor of Psychiatry at the Medical Center and the lead researcher. “This finding is important because, when assessing if a women is at risk of antenatal or postnatal depression, previous pregnancy loss is usually not taken into account in the same way as other risk factors such as a family history of depression, stressful life events or a lack of social support.”

“We know that maternal depression can have adverse impacts on children and families,” Robertson Blackmore said. “If we offer targeted support during pregnancy to women who have previously lost a baby, we may be able to improve health outcomes for both the women and their children.”

Pregnancy loss by miscarriage or stillbirth affects more than an estimated one million women in the United States annually. Between 50 and 80 percent of women who experience pregnancy loss become pregnant again.

The researchers studied 13,133 pregnant women in the United Kingdom who were taking part in a long-term study known as the Avon Longitudinal Study of Parents and Children. The women were asked to report the number of previous miscarriages and stillbirths they had experienced. They were assessed for symptoms of depression and anxiety twice during their pregnancy and four times after giving birth, at 8 weeks, 8 months, 21 months and 33 months. The majority of women reported no miscarriages. But 2,823 women, or 21 percent, reported having one or more previous miscarriages, while 108 reported having one previous stillbirth and three women had two previous stillbirths.

“We found no evidence that affective symptoms associated with previous prenatal loss resolve with the birth of a healthy child. Rather, previous prenatal loss showed a persisting prediction of depressive and anxiety symptoms well after what would conventionally be defined as the postnatal period,” the researchers concluded.

Of the women who had one miscarriage or stillbirth before giving birth to a healthy child, for example, almost 13 percent still had symptoms of depression 33 months after the birth. of those with two previous losses, almost 19 percent had symptoms of depression 33 months after the birth of a healthy child.

Prenatal loss is not routinely considered a risk factor for antenatal or postpartum depression in the same way as, for instance, personal or family history of depression, exposure to stressful life events or lack of social support, according to the study. Routinely assessing loss history would be valuable as a predictor of current and postpartum risk and as a possible marker for intervention, the researcher.

“Given the adverse outcomes of persistent maternal depression on both child and family outcomes, early recognition of symptoms can lead to preventive interventions to reduce the burden of illness, provide coping strategies to reduce anxiety and depression and promote healthy adjustment of the mother, family and child,” the researchers stated.

more information: Robertson Blackmore E, Côté-Arsenault D, Tang W, Glover V, Evans J, Golding J and O’Connor TG. Previous prenatal loss as a predictor of perinatal depression and anxiety. British Journal of Psychiatry, ePub ahead of print 3 March 2011, doi: 10.1192/bjp.bp.110.083105

Provided by University of Rochester Medical Center (news : web)