A baby – yesterday
This morning I woke to these motivating, uplifting words on the radio news bulletin…”Diabetic women are four times more likely to have a child with birth defects. This is because they struggle to control their blood sugars.” Well happy Monday everyone.
Now, we all know how hard it is to please a diabetic so I’m not going to whinge about such things being talked about. The importance of blood sugar control in pregnancy is something we should be aware of, and is something that isn’t often talked about. Still, it wasn’t the nicest thing to wake up to on a Monday morning. “Your type will never breed successfully, and by the way it’s raining outside” doesn’t inspire you to jump out of bed with a smile on your face and a song in your heart. And if I was a pregnant diabetic woman, I think I would probably be hiding under the bed refusing to get out, for fear of what other doom-laden proclamations were going to brighten up the day for me before I’d even had breakfast.
So, to add a bit of balance to the rest of the headlines, and because ShootUp does try to occasionally provide some form of useful content, let’s look at the rest of the story:
Women with diabetes are at an increased risk of having a baby with a birth defect.
BUT, the vast majority of pregnancies in women with diabetes don’t involve a birth defect.
AND, good blood glucose control reduces that risk significantly, especially around the time of conception, so it’s a nice idea to get the diabetes under control before planning pregnancy.
Ah, fancy that, it isn’t an inevitable tragedy waiting to happen, it’s a real risk that needs to be acknowledged but that we can do something about. Now that’s something that’s much easier to live with. Now diabetic women all over the country have calmed down a bit, you can get the full facts here.
I had to have fertility treatment, and because I was ‘in the system’ I went to anti-anti-natal at the maternity hospital – not ideal, seeing all those pregnant and those with babies, BUT it refined my control and I was given folic acid etc (which was not on offer usually at that time). I do think this is a good idea and should be something all diabetic women should be made aware of – if you planning a pregnancy, then go and get help to make sure you are as well controlled as possible. Because those birth defects are almost wholly brought about in those sensitive first few weeks when you might not know you are pregnant. (I’ve seen the results of not being controlled, not personally, and it can be truly dreadful).
Now isn’t that an informative, constructive view on this, couldn’t agree more @Lizz.
I was diagnosed with type 1 at 33 and just 6 weeks after I got married. I will always remember the reg I saw after a fun night on medical admissions who asked if i was planning a family. And then helpfully said “because you won’t be getting pregnany for at least 2 years now”.
Within 4 years of this I had given birth to 2 healthy, normal sized girls and one was even born with a minimum of medical intervention on a midwife led unit.
Welcome to ShootUp Joy. Nice story 🙂
I offer zero medical knowledge or experience on this subject apart from a point raised by Ben Goldacre last month (one of his bugbears – although I can’t find the link where I read it). The headline of “four times” is much more scary than the actual difference of 5.3% – 1.9% chance for non-Ds and 7.2% for diabetics.
Although the sample of 400k women is a decent amount the number of diabetics was only 1677. The research was between 1996 and 2008 i.e. started 16 years ago when pregnancy care may have been differently handled for diabetics. There is also no split between type ones and twos and also no indication if the defects were caused by non-diabetic factors.
Overall an easy headline and the important quote by DUK is almost lost in the study: “We need to get the message out to women with diabetes that if they are considering becoming pregnant, then they should tell their diabetes healthcare team, who will make sure they are aware of planning and what next steps they should be taking.”
Nicely picked apart Dave! As you say the “four times thing is entirely dependent on your starting point.
Oh, and if you’re a fan of Ben Goldacre then you will possibly like Irrationality by Stuart Sutherland http://www.amazon.co.uk/Irrationality-ebook/dp/B0046ZRNLE/. A cynic might say that BG gets quite a lot of his material from it…
I had my two 24 years ago and 19 years ago – I don’t think care has changed a great deal.
I understood that the ladies who have gestational diabetes are more at risk because they are not tested for diabetes until week20+. Those with type 1 are more likely to be aware of the tighter control needed and will be working towards it. I’m not up-to-date with pregnancy info these days but 15 years ago my team were very adamant that my Hba1c had to be better before trying. Went on to have a son and twins (1 of each) all healthy.
Caused by a combination of ‘news’ needing a quick means of filling content and medical research charities needing to raise funds to keep researchers in a job.
@Dave has it spot on ‘The headline of “four times” is much more scary than the actual difference of 5.3% – 1.9% chance for non-Ds and 7.2% for diabetics.’ Unfortunately, I suspect Joe Public isn’t that good at maths to understand that, so it’s a good fund raising ploy; although bad science.
http://www.bbc.co.uk/news/health-12306579 talks of success with an artificial pancreas that would help pregnancy but you guessed it; it needs more research – who would have thought that? While they are doing the research others will be using Pump, CGMS and their Mk1 brain to solve the problem – so research is behind the curve again, and they want donations – I don’t think so.
Happy Monday me! I might not go out – found out on Thursday that I’m 5 weeks up the duff! (haven’t even told the parents yet so consider yourselves v privelidged!))
I discussed our plans with my consultant a few months ago and she was happy for us to start trying with my A1c at 6.7.
Despite my best efforts my control for the last few weeks has been pretty ropey to be honest. It’s ridiculously hard work and extremely stressful already. The next 8 months scare the crap out of me!
Ah, wonderful news! Congratulations! Do let us know how you get on – but I’m sure you will be fine!
Congratulations @bellebe, that’s wonderful news.
Fantastic news. Congratulations @bellebe. So exciting!! 🙂
Excellent news! You will be fine don’t worry your bloods always get screwed up with so many hormones flying around it is to expected. Just do your best. Very exciting keep us posted how you get on.
Congratulations!
You might find you get to eat a bit more “naughty” things through your pregnancy like my little sister… she fell pregnant by accident due to the contraception they were using failing and neither of us have had the best track record of tight sugars (though I like to think I’m a lot better behaved than she was, but she has at least 8 years more experience than me – she was 6 when she was diagnosed, I was 18 and there’s only 3 years between us in age)… Anyway… While she was pregnant she found my nephew was zapping the sugar out of her all the time so she had to eat a lot of sugary/carby things to compensate and her levels were the best they had ever been in her life I think!
There’s more coverage of this over on the NHS’s debunking website:
Diabetes during pregnancy ‘may raise birth defect risk’ – Health News – NHS Choices http://betes.co.uk/576km
@Tim There’s more coverage of this over on the NHS’s debunking website: http://betes.co.uk/576km
Got to ask the question has this research added anything to the fountain of knowledge? I don’t think so and neither does the website.
So why undertake the research; too many staff looking to fill their time at Newcastle University, the Regional Maternity Survey Office in Newcastle, and the South Tees NHS Trust, who carried out the research? I know a very effective solution for too many staff.