Better pre-pregnancy support for women with diabetes needed as study shows poor health behaviours

Women with diabetes who are at greater risk of pregnancy complications need more information and support to change their lifestyle behaviours before conceiving, a study showing poor diet and obesity, lack of exercise, low adherence to folic acid supplementation and high levels of smoking suggests.

Research led by King’s College London looked at data on BMI, smoking, diet, exercise and folic acid intake collected through our online Planning for Pregnancy tool over a year (2019-20) to find out about the health behaviours 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, so 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. 

Of the 84,359 people who used the planning tool, 668 said they had type 1 diabetes, 707 had type 2 diabetes, and 1,785 had developed gestational diabetes in a previous pregnancy. 

Led by Dr Sara White, an 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.  

When planning to have a baby, taking folic acid tablets for 2 to 3 months before conceiving is advised to give time for build-up in the body that gives the most protection for a baby against neural tube defects, such as spina bifida. While most women are advised to take a 400mcg supplement every day, people – such as those with diabetes – who are at higher risk of having a pregnancy affected by neural tube defects are advised to take a higher dose. 

Smoking is a risk factor for stillbirth in the general maternity population and women with diabetes are at greater risk of stillbirth, yet the study found that approximately 1 in 5 women with pre-existing diabetes reported smoking.   

Another important finding was that few women had consulted a GP or specialist before pregnancy, showing that work needs to be done to make sure women and birthing people with diabetes understand the support available to help them plan and prepare for pregnancy. Clinicians and health care professionals can help with advice and support around diabetes management and the use of safe medication, helping to reduce their risks.  

Our Planning for Pregnancy tool provides personalised advice to women with pre-existing diabetes or previous gestational diabetes to improve health before pregnancy.  

With the growing recognition that interventions in pregnancy are often too little, too late, a digital tool to identify women planning pregnancy who are at greater risk, and targeted health advice, may reduce pregnancy complications, the research team say. 

Dr White says:

“It’s positive news that large numbers of women are using the Tommy’s pre-conception 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 behaviour among women who are at a greater risk of experiencing problems during pregnancy.”  

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, our data indicates that such behaviours 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:

“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.”