Women with Type 1, or Insulin Dependant Diabetes (IDDM) are at increased risk for complications during pregnancy and delivery. Because of the complex metabolism of diabetes during pregnancy, both the mother and the developing child are at high risk for serious health consequences, including death.
Researchers and physicians alike are working to find diagnostic criteria to help determine an individual woman's risk for complications during her pregnancy. This key piece of information found early in the pregnancy can hopefully help to prevent the complications or to prepare the family for a less than optimal outcome.
The greatest risks during a pregnancy complicated by IDDM happen to the developing fetus. Brain damage, birth defects, and even death are a possibility of blood sugar control is poor.
Recent findings published in the journal Diabetes Care found that monitoring a woman's Hemoglobin A1c (HbA1c) during the first trimester can help determine risk of complications for the fetus.
A normal HbA1c level is usually from 4-6 percent. IDDM patients can have HbA1c levels above 10, especially if their diabetes is under poor control. HbA1c levels will increase in response to higher than normal average blood sugar values, especially if the elevation persists over time.
Researchers in Denmark looked at HbA1c levels in more than 530 IDDM pregnant women and compared them to the final pregnancy outcomes.
There was not a large difference in the average HbA1c levels among positive and negative outcome groups. But a trend was observed between HbA1c levels and pregnancy outcome that is highly clinicaly relevant.
For every 1 percent increase in HbA1c, a woman's risk for poor or negative pregnancy outcome increases by 5.5 percent. Women with a HbA1c above 10 have a 1 in 5 chance of a positive or good outcome.
There seems to be more to the association, because women with an HbA1c of 6 percent or less still have a 15 percent chance of a poor outcome.
More research into this area is under way, but for any woman with IDDM the message is clear. Keep good control of the diabetes. It may be helpful to have your HbA1c checked prior to becoming pregnant. Many treatment options for IDDM can lower the HbA1c, thereby potentially increasing the chance that a pregnancy may end well.
Posted by Dr. Christina Gutierrez on December 27, 2006 10:53 PM
