Type 1 diabetes impairs female fertility even before it is diagnosed

Lin, Yung-Hsiang; Chen, Ko-Jung; Peng, Yun-Shing; Chen, Pau‐Chung

doi:10.1016/j.diabres.2018.07.010

Cited by 34 publications

(23 citation statements)

References 22 publications

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“…First, T1D prevalence is much lower in China than in Caucasian populations [ 22 ]. Moreover, a nationwide cohort study in Taiwan recently reported that T1D greatly impairs female fertility [ 23 ]. As a result, although all pregnant women with T1D who gave birth between 1 January 2006 and 31 May 2018 were included, the sample size of the study was relatively small.…”

Section: Discussionmentioning

confidence: 99%

Real-World Experience of Adding Metformin in Pregnant Women with Type 1 Diabetes in a Chinese Population: A Retrospective Cohort

et al. 2019

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Introduction Glycemic control in pregnant women with type 1 diabetes (T1D) is challenging with only insulin, and the incidence rate of adverse perinatal outcomes is high. Increasing data have indicated the safety and effect of metformin in pregnancy; however, no relevant data are available in pregnant women with T1D. We aimed to investigate glycemic control and perinatal outcomes in pregnant women with T1D in a Chinese population and explored the role of metformin in these patients. Methods We obtained data of 38 pregnant women with T1D who received regular antenatal care and delivered at Peking Union Medical College Hospital (PUMCH) between 1 January 2006 and 31 May 2018. The perinatal outcomes of T1D patients who added metformin as adjunct treatment and those who remained on insulin-alone therapy were compared retrospectively. Results Being overweight was common (35.1%) in pregnant women with T1D. On average, the insulin dose increased by 35.30 ± 22.60 unit/day during pregnancy. The cesarean delivery rate was high (65.8%), and fetal macrosomia was the main reason. The change of HbA1c in the metformin-insulin group was more prominent than in the insulin-only group (− 1.47 ± 1.17% vs. − 0.90 ± 1.13%, p = 0.05). There was no statistically significant difference in perinatal outcomes between the two groups. Conclusions The incidence of adverse perinatal outcomes in pregnant women with T1D was high. This study innovatively suggested that metformin could be safe and could contribute to improving glucose management in pregnant women with T1D.

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Section: Discussionmentioning

confidence: 99%

Real-World Experience of Adding Metformin in Pregnant Women with Type 1 Diabetes in a Chinese Population: A Retrospective Cohort

et al. 2019

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“…T1DM complicates a relatively small percentage of pregnancies (~1 of 200). Nevertheless, women with T1DM experience fewer livebirths (Lin et al 2018), higher early pregnancy terminations (Sjöberg et al 2017) and a greater risk for preterm births (Ludvigsson et al 2019) than the general population. Increased infiltration and adhesion of monocytes to placental bed endothelium leading to inflammation and reduction of placental blood flow have been suggested to partly underlie these poor birth outcomes in women (Galettis et al 2004) and were mechanistically confirmed in non-obese diabetic mice (Burke et al 2007).…”

Section: Compromised Reproductive Healthmentioning

confidence: 99%

Co-morbidity of type 1 diabetes and endometriosis: bringing a new paradigm into focus

Simmen

Brown

Quick

et al. 2019

Journal of Endocrinology

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Type 1 diabetes mellitus and endometriosis separately affect millions of women worldwide. Reproductive-age women diagnosed with type 1 diabetes may also suffer from endometriosis, but the asymptomatic pre-clinical period of highly variable duration for each condition can lead to challenges in the timely recognition of co-morbid disease onset and misdiagnosis. While knowledge of the pathogenesis of each condition has grown substantially, co-morbid endometriosis and type 1 diabetes has not been widely considered and much less addressed. This review discusses the molecular rationale for the likelihood of their co-existence, and prospects for improvements in therapeutic strategies and reduced complications, if this paradigm is included as a significant variable in disease management.

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“…Maternal and neonatal morbidity in patients with type 1 diabetes mellitus (T1DM) is well documented, with higher chances of preeclampsia, preterm birth, perinatal mortality, hypoglycemia, retinopathy, hypertension, nephropathy or diabetic ketoacidosis [2,3]. On one hand these patients have reduced rate of pregnancy -partially due to lower fertility [4], but on the other hand the prevalence of T1DM is increasing among the youth [5]. Therefore, the tendency is to increase the number of pregnant with T1DM and obstetricians have to be aware of severe outcomes and complications of these patients.…”

Section: Introductionmentioning

confidence: 99%

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 diabetes mellitus at a university hospital in São Paulo, Brazil: a retrospective study

Morais

Patz

Campanharo

et al. 2020

BMC Pregnancy Childbirth

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Background To date, the rates of potentially life-threatening condition (PTLC), maternal near miss (MNM) and maternal deaths in pregnant patients with type 1 diabetes mellitus (T1DM) and variables associated to it have not been studied. Methods This study was as a cross-sectional retrospective study conducted at São Paulo Hospital of Universidade Federal de São Paulo, a tertiary hospital that provides public medical care through the Brazilian unified health system to high-risk pregnancies. Inclusion criteria were T1DM pregnant women who delivered from January 2005 to December 2015. Three groups were established by the World Heath Organization criteria and associations were assessed using the chi-square test in between MNM and no morbidity or PLTC and no morbidity. A P value < 0.05 was considered statistically significant. Results The final sample included 137 patients, 8 MNM cases (5.84%), 51 PLTC (37.23%), no cases of maternal deaths and 78 patients (56.93%) did not present any complication. Moreover, there were 122 live births, resulting in a near miss rate of 65.5 per 1.000 live births in patients with T1DM. Two of the MNM cases were for clinical criteria (uncontrollable fit in both) and laboratory criteria for the other six: one patient with severe acute azotemia (creatinine > 300 μmol/ml), one patient with severe hypoperfusion (lactate > 5 mmol/L) and four of them with loss of consciousness and the presence of glucose and ketoacids in urine. PLTC criteria were studied in MNM and PLTC cases. Prolonged hospital stay was the most prevalent PLTC criteria in both groups (100% of MNM cases and 96% of PLTC), followed by renal failure in 50% of MNM cases and severe preeclampsia in 22% of PLTC cases. This study could not find any association between prenatal factors or sociodemographic characteristics with maternal morbidity. Conclusions MNM rate in T1DM was extremely high, and determined by complications of the primary disease or hypertensive disorders. No sociodemographic variables studied were related to maternal morbidity; therefore, we could not predict what increases MNM and PLTC in this specific population.

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Type 1 diabetes impairs female fertility even before it is diagnosed

Abstract: Type 1 diabetes compromises female fertility, even before it is diagnosed. Associated hyperthyroidism further reduces fertility. Blood glucose and thyroid function surveillance in infertile females may allow for an early diagnosis of type 1 diabetes and associated thyroid disease.

Cited by 34 publications

References 22 publications

Real-World Experience of Adding Metformin in Pregnant Women with Type 1 Diabetes in a Chinese Population: A Retrospective Cohort

Real-World Experience of Adding Metformin in Pregnant Women with Type 1 Diabetes in a Chinese Population: A Retrospective Cohort

Co-morbidity of type 1 diabetes and endometriosis: bringing a new paradigm into focus

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 diabetes mellitus at a university hospital in São Paulo, Brazil: a retrospective study

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