Optimizing pregnancy outcomes for type-1 diabetes ‘moms-to-be’
Forty years ago, many women with type-1 diabetes were discouraged from having children because of severe childbirth complications that resulted from having the disease. While more women with type-1 diabetes are having healthy babies today as a result of new treatment options, outcomes can still be improved. “We’ve come a long way but have not come far enough,” says Dr. Denice Feig, endocrinologist and head of the Diabetes in Pregnancy program at Mount Sinai Hospital’s Leadership Sinai Centre for Diabetes.
Dr. Feig is the principal investigator, leading a major international study that looks at the effectiveness of Continuous Glucose Monitors (CGM) during pregnancy and pre-pregnancy, to determine whether such devices will help pregnant women with type-1 diabetes, and those planning to get pregnant, better manage their blood glucose levels and reduce birth complications. The CGM device consists of a small sensor, two inches in diameter, which is inserted under the skin of the abdomen and transmits blood sugar readings to a small monitor every five minutes.
Dr. Denice Feig reviews blood glucose level readings from a CGM device with a patient who has type-1 diabetes, at Mount Sinai's Leadership Sinai Centre for Diabetes.
CGMs have already proven to be very effective for blood glucose management in adults outside of pregnancy. “Anyone can buy the CGM device, but it is expensive,” says Dr. Feig. “If we show there is a benefit to using CGMs during pregnancy and pre-pregnancy, we hope more women will use the device and governments will help support those who can’t afford to pay for them.”
Women with type-1 diabetes and their infants are at an increased risk of having complications such as preeclampsia, preterm delivery, birth injuries, still births, congenital anomalies, and NICU admissions. In order to minimize risk, these women need to pay very close attention to their blood glucose levels during pregnancy and even before conception. Current practices include manually withdrawing blood several times a day, insulin pumps, frequent physician check-ups and monitoring diet and exercise. The CGM device allows patients to have nearly constant feedback of their blood sugar levels and provides more accurate cues of when best to take corrective action.
Dr. Feig’s international CGM study launched a year ago in Canada, UK, Spain, Italy and the US. To participate in the trial, women must either be planning to conceive within six months or be in early pregnancy, up to 13 weeks. They also must be willing to wear the CGM device 24 hours/day. Half of the women will receive CGM devices and the other half will receive the current standard of type-1 diabetes care. Women of both groups will meet regularly with clinicians who will help manage their diabetes. Researchers will pay close attention the mothers’ glucose monitoring management, how well they respond and tolerate the device and will track the results of childbirth.
Dr. Feig’s research focus combines two areas of strength at Mount Sinai hospital, Diabetes and Women’s and Infants’ Health. Mount Sinai’s diabetes researchers rank number one in the world and the hospital also has the largest neonatal research program in the country.
“With excellent glycemic control and high-risk obstetric care prior to and during pregnancy, our goal is to optimize fetal outcomes for women who are living with type-1 diabetes,” says Feig.
The CGM study is being supported by the Juvenile Diabetes Research Foundation and is being led out of Mount Sinai Hospital in Toronto. To participate in the trial or to learn more call 416-586-8590.
