Women with diabetes who want to start a family are being urged to monitor their blood glucose levels and take a daily high dose of folic acid, as a new study reveals the extra risks to their baby's health.

Researchers from Newcastle University found that the risk of stillbirth or death during the first year of life was over four times greater in women with diabetes than in those without; with no evidence that this had improved. The risks were similar for women with type 1 and type 2 diabetes and were reduced in women with well controlled blood glucose levels.

The study also found that women with diabetes who had taken folic acid supplements before pregnancy had half the risk of a stillbirth or death during the first year of life.  However, only 40% of women took these supplements.

Diabetes deaths could be avoided

In the paper, to be published today in the journal Diabetologia, the team from Newcastle studied the outcomes of over 400,000 pregnancies delivered in the North of England between 1996 and 2008. They found that 2.7% of births in women with diabetes resulted in stillbirth, six times than rate for women without diabetes, while 0.7% died during the first year of life, nearly double the rate in women without diabetes.  The research found that nearly 40% of deaths might have been avoided if all of the women were able to achieve good control of their blood glucose before pregnancy.

Dr Ruth Bell, who specialises in maternal and perinatal health at Newcastle University and who led the research, said: “It's disappointing to see so little improvement because, with the right care, most women with diabetes can - and will - have a healthy baby. Stillbirths and infant deaths are thankfully not common, but they could be even less common if all women with diabetes can be helped to achieve the best possible control of their blood glucose levels before becoming pregnant.

“We already know that folic acid reduces the risk of certain congenital anomalies, such as spina bifida or cleft lip, which is why women with diabetes are advised to take high dose supplements of 5 milligrams daily. These are available on prescription and should be taken for at least 3 months before conceiving.  Our results suggest this simple action may also help to reduce the risk of stillbirth or infant death even in babies without these conditions.”

Planning a pregnancy

Professor Rudy Bilous, professor of clinical medicine at Newcastle University and Consultant at South Tees NHS Foundation Trust, offers some advice: “Firstly, if you are planning a pregnancy, and your blood glucose levels are high, then any reduction -even a small one - is likely to be good for your baby. Secondly, seek advice as early as possible from your diabetes team. They can help you keep your glucose at safe levels, as neither high blood glucose nor repeated episodes of severe hypoglycaemia are good for you and your baby.”

This is one of the largest studies of its type ever conducted. It was made possible by NHS clinical teams throughout the region working together to collect information about pregnancies in women with diabetes and improve the services provided.

published on: 28 November 2013