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Rapporteur report

Professor Fidelma Dunne

30 January 2017

HRB-funded research achieves impressive results to prevent and manage diabetes in pregnancy

Watch Prof Dunne's presentation on You Tube at the link below

Quick summary:

  • Diabetes in pregnancy (whether pre-existing or arising in pregnancy) can cause immediate and long-term health problems for both mother and baby 
  • The HRB-funded Atlantic DIP study gathered put in place interventions to help women prepare for and manage diabetes in pregnancy
  • Pregnancy outcomes for women with pre-existing diabetes in the region are now almost comparable to the background population 
  • Gestational diabetes is more common than previously assumed, but low-cost interventions are effective at improving outcomes.

When Consultant Endocrinologist Professor Fidelma Dunne started looking in 2006 for hard evidence about diabetes in pregnancy in Ireland, there was little to be found. 

It has long been known that having diabetes in pregnancy - whether it’s Type 1 (where the pancreas does not make enough insulin), Type 2 (where the body does not respond appropriately to insulin) or ‘gestational’ diabetes that develops in pregnancy – bumps up the risk of high blood pressure and pre-eclampsia, premature birth, Caesarean sections, stillbirth and congenital malformations or ‘macrosomic’ oversized babies who may be at increased risk of disease as adults.

But ten years later, thanks to the HRB-funded Atlantic Diabetes in Pregnancy (DIP) Project led by Professor Dunne, a Professor at the School of Medicine in NUI Galway, diabetes in pregnancy is less of an issue for women attending five hospitals in the west of Ireland. 

Diabetes affects an estimated 7,200 pregnancies each year in Ireland, and when Professor Dunne and colleagues collected evidence, she was  ‘really disappointed and horrified to see that in pregnancies complicated by diabetes, congenital malformation rates were twice as common, stillbirth was five times as common and perinatal mortality was three time as common as women in the region who did not have diabetes’. 

‘Of utter shame to all of us providing care was that 50% of these babies were born macrosomic or large, therefore posing these children for future health problems as adults’, said Professor Dunne, who noted that the health of mothers was also at risk. ‘The horrifying fact that 5 years post the index pregnancy with GD, almost 26% of these women continued to have pre-diabetes and diabetes when we compared them to a matched control group of women who did not have diabetes in the index pregnancy’. 

Interventions 

Spurred on by the desire to improve outcomes for mothers and babies, the Atlantic DIP study designed, implemented and evaluated a pre-pregnancy care programme for women in the region to improve outcomes. And it worked, as Professor Dunne explained. 

‘Any serious adverse event was reduced significantly, we almost eliminated congenital malformations and we have been able to reduce neonatal unit care by a third’, she said, adding that economic evaluation showed a healthcare saving of 2577 Euro for each woman. 

‘We can now say we have optimised care for women with Type 1 and Type 2 diabetes, and the outcomes of these pregnancies are now very close to background population. It is a significant improvement from where we started in 2006’. 

The Atlantic DIP study also pinned down the prevalence of gestational diabetes. A study in 2000 in one hospital had found a prevalence of 2.7%, but the newer, larger study showed it was about 12.4%, and that pushed up the risk of complications such as pre-eclampsia for the mother and premature birth or macrosomia for the baby. 

‘We changed our practice’, recalled professor Dunne. ‘We implemented uniform screening in the region, we developed a multi-professional service, each woman got good healthcare’. 

Again, the intervention worked: for women who controlled gestational diabetes with diet, the rates of macrosomia were eliminated compared to pregnancies with normal glucose. ‘This is so satisfying’, said Professor Dunne, who would like to see more widespread screening for diabetes in pregnancy reviewed for its effectiveness.

While work is ongoing, to date the decade-long study has demonstrated how we can deliver healthcare differently and achieve outcomes without additional staff, according to Professor Dunne.   ‘We have taken the answers to our clinical problems and changed the way we deliver healthcare’, she said. ‘We now have a regionalised system of healthcare for these women that offers care before, during and after pregnancy…We have shown that it is cost effective, and in all of this development we have had patient involvement, which is key to success’.

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