Issues to be Solved: Future Perspectives

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Comprehensive Clinical Approach to Diabetes During Pregnancy

Abstract

Many advances have been achieved during the previous decade on the field of diabetes mellitus (DM) in pregnancy; however, there are still important issues to be solved. The aim of this chapter is to present such issues and to discuss future perspectives in terms of clinical care and future research priorities both for pre-existing DM and gestational diabetes mellitus (GDM). Preconception period and first trimester is essential to improve pregnancy outcomes for women with pre-existing DM, while more should be done regarding the use of new technologies. The need of early diagnosis of GDM and the investigation of the long-term maternal and offspring effects of GDM and various interventions need to be explored. All the above require global collaboration of scientists, health economics experts’ involvement, and governmental decisions for the translation of new discoveries into the best clinical practice.

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References

  1. Saravanan P, Diabetes in Pregnancy Working Group; Maternal Medicine Clinical Study Group; Royal College of Obstetricians and Gynaecologists, UK. Gestational diabetes: opportunities for improving maternal and child health. Lancet Diabetes Endocrinol. 2020;8:793–800.

    Article  Google Scholar 

  2. Schaefer-Graf U, Napoli A, Nolan CJ, Diabetic Pregnancy Study Group. Diabetes in pregnancy: a new decade of challenges ahead. Diabetologia. 2018;61:1012–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Colstrup M, Mathiesen ER, Damm P, Jensen DM, Ringholm L. Pregnancy in women with type 1 diabetes: have the goals of St. Vincent declaration been met concerning foetal and neonatal complications? J Matern Fetal Neonatal Med. 2013;26:1682–6.

    Article  CAS  Google Scholar 

  4. Macintosh MC, Fleming KM, Bailey JA, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006;333:177.

    Article  Google Scholar 

  5. Wahabi HA, Alzeidan RA, Esmaeil SA. Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health. 2012;12:792.

    Article  Google Scholar 

  6. American Diabetes Association. Management of diabetes in pregnancy: standards of medical care in diabetes 2020. Diabetes Care. 2020;43(suppl 1):S183–92.

    Article  Google Scholar 

  7. Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPT): a multicentre international randomised controlled trial. Lancet. 2017;390:2347–59.

    Article  CAS  Google Scholar 

  8. Stewart ZA, Wilinska ME, Hartnell S, et al. Closed-loop insulin delivery during pregnancy in women with type 1 diabetes. N Engl J Med. 2016;375:644–54.

    Article  CAS  Google Scholar 

  9. Fresa R, Visalli N, Di Blasi V, et al. Experiences of continuous subcutaneous insulin infusion in pregnant women with type 1 diabetes during delivery from four Italian centers: a retrospective observational study. Diabetes Technol Ther. 2013;15:328–34.

    Article  CAS  Google Scholar 

  10. Ringholm L, Mathiesen ER, Kelstrup L, Damm P. Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding. Nat Rev Endocrinol. 2012;8:659–67.

    Article  CAS  Google Scholar 

  11. Zeisler H, Llurba E, Chantraine F, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected pre-eclampsia. N Engl J Med. 2016;374:13–22.

    Article  CAS  Google Scholar 

  12. Concillado M, Lund-Andersen H, Mathiesen ER, Larsen M. Dexamethasone intravitreal implant for diabetic macular edema during pregnancy. Am J Ophthalmol. 2016;165:7–15.

    Article  CAS  Google Scholar 

  13. Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4:1025–36.

    Article  Google Scholar 

  14. Abenhaim HA, Alrowaily N, Czuzoj-Shulman N, Spence AR, Klam SL. Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women. J Matern Fetal Neonatal Med. 2016;29:3596–601.

    Article  Google Scholar 

  15. Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372:814–24.

    Article  CAS  Google Scholar 

  16. Dalfrà MG, Busetto L, Chilelli NC, Lapolla A. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. 2012;25:1537–43.

    Article  Google Scholar 

  17. Catalano PM, Mele L, Landon MB, et al. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth? Am J Obstet Gynecol. 2014;211:e131–7.

    Article  Google Scholar 

  18. Hinkle SN, Sharma AJ, Dietz PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr. 2010;92:644–51.

    Article  CAS  Google Scholar 

  19. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86.

    Article  CAS  Google Scholar 

  20. Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48.

    Article  CAS  Google Scholar 

  21. Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

    Article  Google Scholar 

  22. Hattersley AT, Patel KA. Precision diabetes: learning from monogenic diabetes. Diabetologia. 2017;60:769–77.

    Article  Google Scholar 

  23. Houshmand-Oeregaard A, Hansen NS, Hjort L, et al. Differential adipokine DNA methylation and gene expression in subcutaneous adipose tissue from adult offspring of women with diabetes in pregnancy. Clin Epigenetics. 2017;9:37.

    Article  Google Scholar 

  24. Kim H, Toyofuku Y, Lynn FC, et al. Serotonin regulates pancreatic beta-cell mass during pregnancy. Nat Med. 2010;16:804–8.

    Article  CAS  Google Scholar 

  25. Horn S, Kirkegaard JS, Hoelper S, et al. Research resource: a dual proteomic approach identifies regulated islet proteins during β-cell mass expansion in vivo. Mol Endocrinol. 2016;30:133–43.

    Article  CAS  Google Scholar 

  26. Apostolakis M, Paschou SA, Zapanti E, et al. HbA1c presents low sensitivity as a post-pregnancy screening test for both diabetes and prediabetes in Greek women with a history of gestational diabetes mellitus. Hormones (Athens). 2018;17(2):255–9.

    Article  Google Scholar 

  27. Allalou A, Nalla A, Prentice KJ, et al. A predictive metabolic signature for the transition from gestational diabetes mellitus to type 2 diabetes. Diabetes. 2016;65:2529–39.

    Article  CAS  Google Scholar 

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Paschou, S.A., Goulis, D.G. (2022). Issues to be Solved: Future Perspectives. In: Goulis, D.G. (eds) Comprehensive Clinical Approach to Diabetes During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-030-89243-2_24

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  • DOI: https://doi.org/10.1007/978-3-030-89243-2_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-89242-5

  • Online ISBN: 978-3-030-89243-2

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