Diabetes and Pregnancy Experts Highlight Need for Tailored Tech and Care
Key takeaways:
- Advancements in care and technology have led to successful pregnancies in most women with diabetes.
- Technology, including AID and CGM devices, can improve outcomes, but ensuring their use and widespread access is challenging.
- Pre-pregnancy planning and personalized care for women with diabetes are vital considerations, experts said.
A panel of specialists from around the world called for customized technology that addresses the needs of expectant mothers with diabetes while emphasizing personalized pregnancy care, and the importance of pre-pregnancy planning to ensure the health of mothers and newborns.
The panel, held in Madrid during the 2024 European Association for the Study of Diabetes (EASD) annual meeting, was led by Dr. Helen Murphy, a professor of medicine at the University of East Anglia and a practicing clinician. Murphy was joined by:
- Dr. Ananta Addala, a pediatric endocrinologist at Stanford University
- Dawn Adams, midwife and researcher at Southern Health and Social Care Trust, Northern Ireland
- Dr. Elisabeth R. Mathiesen, a professor of clinical medicine at the University of Copenhagen
- Dr. Arianne Sweeting, a senior lecturer in endocrinology at the University of Sydney
Improved outcomes in pregnancy with diabetes
Murphy's comprehensive experience includes research on pregnant women with diabetes who used an automated insulin delivery (AID) system developed at Cambridge University, called CamAPS FX.
The only AID system currently approved for pregnant women with diabetes, CamAPS FX was FDA-approved in May 2024 and is available for Android phones, but is not currently available in the U.S.
Murphy acknowledged the current challenges faced by expectant mothers with diabetes, which include tighter glucose targets, ongoing hormonal changes, and adjustments to diet. But she began the discussion with a hopeful message.
"The single most important thing to know is that once you get beyond the first trimester, 98.8% of women with diabetes will leave the hospital with a baby in their arms," Murphy said. "The outcomes for women with diabetes have never been better. We should keep an eye on the bigger picture, which is that women with diabetes can expect to have healthy, normal babies."
Murphy then turned to midwife Dawn Adams and asked how care for pregnancy with diabetes has changed in the last several decades, based on her experience as a practicing midwife, person with type 1 diabetes, and mother of four sons.
Adams recalled using previous-generation insulins during the pregnancy of her first son that were replaced by new insulins that led to much more successful outcomes by the time she had her fourth son, six years later. During her first pregnancy almost 30 years ago, she could only test her blood sugar four times a day compared to the near real-time access from continuous glucose monitoring (CGM) available today.
"We're relatively blessed today to have access to data that was completely unimaginable in 1997 and was still unimaginable when I had my fourth son in 2004," Adams said.
Healthy diet and healthy babies
Dr. Mathiesen said the single most impactful thing a woman with diabetes can do to deliver a healthy baby is to focus on diet.
Mathiesen said when she begins to provide care for a woman with diabetes, she starts by explaining that high blood sugar means the baby is also getting more sugar and is more likely to be obese. AID systems, CGM, and insulin pumps all help, she said, but it's still key to focus on diet, with an emphasis on macronutrients (carbs, protein, and fats) and micronutrients (vitamins and minerals) that allow for healthy weight gain, which promotes better outcomes for the mother and baby.
"This is my main target to try to keep the size of the baby appropriate," Mathiesen said. "The very most important thing is the glucose level. And now we have much better available technology to help our ladies to live a normal life while staying focused on this purpose."
Pre-pregnancy care
The panelists discussed the importance of pre-pregnancy planning for improving the experience of pregnancy as well as the outcome.
Dr. Addala shared her efforts as a pediatric endocrinologist to introduce pregnancy-related concepts to her patients when they begin menstruating, like the relationship between a larger baby and postnatal complications.
"We start those conversations early on, and it's a constant conversation," she said. "This is part of your health, and let's be proactive about it. So when they transition to my colleagues [who care for adults with diabetes], they have an understanding of what they're supposed to do and what it means – emotionally, mentally, sometimes financially – to prepare for having a child."
Addala and Dr. Sweeting both discussed the need for contraception education and pregnancy counseling where possible.
"We want to empower women to have the healthiest pregnancy they can," Sweeting said. "So when we are trying to get to [diabetes-related] pregnancy targets – before pregnancy – we've been as prepared as possible."
Technology access and other challenges
Murphy noted that in 2023, the National Health Service in the U.K. funded CGM use throughout the pregnancy of women with diabetes. Many of the women already were using CGM, but adoption across the board reduced major birth defects and neonatal deaths by a third.
And while technology has assisted in remarkable improvements, it's not a solution unto itself, the panelists noted. There are many challenges to access and cost, especially in underserved communities.
In the U.S., for example, lack of insurance coverage, high deductibles, and other barriers may make technology inaccessible for mothers with diabetes who would greatly benefit from it.
And while technology like CGM and AID tech can be used to eliminate fingersticks and needle injections, panelists said, healthcare practitioners and those they care for need to work together to make sure the technology is put to good use.
"It's not just the uptake, but the sustained and effective use of diabetes technology," Addala said.
Another challenge Addala pointed out is that technology can actually add to the burden of a mother-to-be with diabetes. An example of this sort of tech burden is device failures, she said, which might require a tech support phone call to resolve the problem while balancing other responsibilities.
"That call, which can seem like a fairly simple thing to do, is actually quite challenging when you're juggling multiple jobs, or have limited break times, or don't actually have cell phone access that's reliable,”' she said. "It ends up becoming a toll just to live with diabetes, all of the maternal care that goes into it, plus the higher risk of complications that typically happen in this group, and the amount of distress keeps adding up."
Gestational diabetes considerations
The panelists also discussed the surprise that comes from a diagnosis of gestational diabetes, which can upend a woman's vision of how her pregnancy will go. Adams said the news is also often accompanied by stigma.
"It's a very negative healthcare message if you're pregnant, and at 16 weeks you are told you have gestational diabetes,” Adams said. “Suddenly, it rips that carpet out of your planned pregnancy approach because you've gone from a less medicalized pregnancy to an intensively medicalized pregnancy."
When Adams shares a gestational diabetes diagnosis, she offers assurances from her own experience of successful pregnancies.
Murphy said recent data suggests the extra care women with gestational diabetes receive during pregnancy, which includes additional planning and testing along with an emphasis on diet, statistically has led to healthier babies than in the general population.
The road ahead for technology and pregnancy
Dr. Katrien Benhalima, an endocrinologist from KU Leuven in Belgium, who attended the event, emphasized the importance of AID systems that can be customized to the mother's needs, which change dramatically, week to week, during the pregnancy.
Benhalima conducted a recent study of the Medtronic 780G with a group of pregnant women with diabetes and found a potentially surprising challenge, she said. Some of the women in the study were hesitant to adjust targets, partly because they had become used to the AID system controlling that aspect of their care.
Murphy, who spent 20 years studying the factors that need to be addressed in a hybrid closed-loop system to address the day-to-day variability seen in pregnancy, said the commercial AID systems face many challenges before they are successfully assisting women with diabetes in pregnancy, with regulatory approval necessary at each step of the way.
"It's just they have to do the work that is specific to pregnancy," Murphy said. "I think they will all get there, and I think they'll get there much faster than we did."
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