Improving the odds for expectant mothers
Study targets pregnancy complications related to diabetes
By Susanne Martin, Managing Editor
Starting a family is the dream of many Canadians, and countless medical advances have improved the chances for healthy pregnancies. Yet risks remain, and among those who are more likely to face challenges are expectant mothers with type 1 diabetes (T1D), an autoimmune disease that makes individuals insulin-dependent for life.
Since she was diagnosed at age seven, Stephany Stephenson had to manage her diabetes with insulin injections. Now, at 40, she is looking forward to having a baby with her partner. Yet they’ve learned that pregnancy can be one of the biggest accelerators of diabetic complications, such as kidney failure, blindness and amputation. What’s more, babies of diabetic mothers are also at risk – they are prone to having problems after birth, including breathing difficulties and low blood sugar.
“Managing T1D is already a daily challenge, and preparing for a pregnancy and carrying a child can bring added stress,” says Dave Prowten, Canada’s president and CEO of JDRF, an organization dedicated to T1D research funding and advocacy.
Even before conception – and throughout the pregnancy – women with T1D are advised to keep their blood glucose level as stable as possible to improve their chances, says Stephenson, a difficult task at a time when a woman’s body is undergoing many changes.
When she learned about a JDRF Canadian Clinical Trial Network (JDRF CCTN) study called Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT) that aims to give pregnant women with T1D the tools to better monitor and control their blood glucose levels, Stephenson eagerly signed up.
“CONCEPTT is about healthy moms and healthy babies. Both can experience potentially serious complications during pregnancy and childbirth if the mother’s diabetes is not managed with utmost care,” says Prowten, adding that the study will determine whether new technology can reduce risks and complications associated with T1D pregnancies.
CONCEPTT evaluates the benefit of adding a real-time continuous glucose monitoring (CGM) sensor to the standard therapy that typically relies on self-monitoring of blood glucose, the use of insulin and diet.
What prompted Stephenson to participate is the potential of CGM to reduce the margin of error. “During pregnancy, you have to keep your blood glucose really tight, and that’s challenging,” she explains. “With regular monitoring, you’d literally have to test your blood glucose every hour.”
While Stephenson says she wouldn’t mind the high frequency of standard testing – after all, she knows how important it is for her own and the baby’s well-being – she feels continuous monitoring gives her something more: a certain peace of mind.
Stephenson says before getting the CGM device, she felt she was “catching up all the time.” With the CGM sensor – which is placed on a person’s body and continuously relays blood glucose readings – she knows what her glucose levels are and whether they are trending up or down.
“During pregnancy, you have to keep your blood glucose really tight, and that’s challenging.”
Stephany Stephenson was diagnosed with type 1 diabetes at age 7
“The monitor shows if your glucose level is going higher or lower, and you know at what point you need to adjust your insulin,” she says. “Before you go to bed, for example, you have the opportunity to check and know that you won’t have a reaction in the middle of the night. I find that completely reassuring.”
Stephenson says that maintaining blood glucose control is “much more manageable with CGM,” where a sensor communicates wirelessly with an external device that administers insulin. Yet it is only part of her pregnancy regime.
She regularly consults with her endocrinologist, OB/GYN doctors specializing in high-risk pregnancies, and a diabetes nurse, and also has access to a nutritionist. Before her pregnancy, she underwent stress tests and had her eyes checked.
While she is appreciates the support, Stephenson says she has another reason for participating. If CONCEPTT proves that continuous glucose monitoring can result in fewer pregnancy complications – as she believes it will – the outcome could help expectant mothers with T1D gain access to the device.
“The cost of the sensors is very high, and they’re often not covered by insurance. Hopefully their use could be supported by the government in the future,” she explains, adding that she believes preventative measures like CGM can save health-care dollars in the long run.
“If we can determine that new technology can enable women with T1D to have safer and healthier pregnancies, that would be a significant outcome,” says Prowten, adding that trials such as CONCEPTT help to position Canada as an international hub for diabetes science and innovation.
For Stephenson, taking part in CONCEPTT makes the pregnancy she and her partner have long been planning a little bit less stressful.
For more information, visit jdrf.ca.