Women with diabetes found to show poor health behaviors before pregnancy

Women with diabetes who are at greater risk of pregnancy complications need more information and support to change poor lifestyle behaviors, new research has found.

Research led by King’s looked at data on BMI, smoking, diet, exercise and folic acid intake collected through the charity Tommy’s online Planning for Pregnancy tool over a year (2019–20) to find out about the health behaviors of people thinking about having a baby.

Women and birthing people with diabetes in pregnancy are at greater risk of complications for themselves and their babies—including a higher risk of stillbirth—compared to those without diabetes. Pre-pregnancy care to help them reduce their risk factors is vital.

People who have previously had gestational diabetes are at a greater risk of developing it in a subsequent pregnancy, but changes can be made pre-pregnancy to improve health.

Analysis published in the journal Diabetic Medicine found that at the time of using the tool:

Women with pre-existing type 2 diabetes or previous gestational diabetes had a higher BMI than women with no diabetes.
Nearly two-thirds (65%) of women with type 2 diabetes and nearly half (46%) of women with previous gestational diabetes were living with obesity, compared with a quarter (26%) of women without diabetes
Only around half of women with diabetes or previous gestational diabetes consumed 5 portions of fruit and vegetables at least 4 days a week. This was lowest in women with type 2 diabetes (49%)
The study also showed that less than half of women with diabetes or previous gestational diabetes were taking folic acid before conceiving. Smoking is a risk factor for still birth and women with diabetes are at greater risk of stillbirth, but the study found that one in five women with pre-existing diabetes reported smoking. Few women had consulted a GP or specialist before pregnancy to access support and information to help manage their diabetes.

With low intake of fruit and vegetables, low levels of physical activity, and alcohol and caffeine consumption consistent with previous reports in women planning pregnancy, Tommy’s data indicates that such behaviors are already established before conception amongst these higher risk women. Diet, physical activity and weight should be targeted during pre-pregnancy care, the research team conclude.

Dr. White says, “It’s positive news that large numbers of women are using the Tommy’s Planning for Pregnancy tool—it’s evidence that they want to find out how best to prepare for pregnancy. But the results of our study also show that there is a high level of sub-optimal health behavior among women who are at a greater risk of experiencing problems during pregnancy.

“Preparing for pregnancy is a particular challenge for women with type 2 diabetes, and their healthcare professionals. Pre-pregnancy care is not well-integrated into the routine care of women with type 2 diabetes whereas women with type 1 diabetes are more likely to be cared for by specialist teams.

“Additionally, there is currently no specific support for women who are at a higher risk of developing gestational diabetes in their next pregnancy. Our study shows a clear need for better support and advice for these individuals.”