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Insulin delivery tech supports healthier pregnancies, study finds

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Automated insulin delivery improves glucose control in pregnant women with type 1 diabetes, an international study has revealed.

The technology, which mimics a healthy pancreas, adjusts insulin from a pump in real time using current and predicted glucose.

Keeping glucose in range supports the health of both mother and baby.

An international clinical trial assessed hybrid closed-loop (HCL) insulin therapy — a form of automated insulin delivery that links a glucose sensor to a pump and adjusts doses automatically — against standard injections or non-automated pumps with continuous glucose monitoring.

Type 1 diabetes in pregnancy carries increased risks including miscarriage, pre-eclampsia (dangerous spikes in blood pressure) and other serious complications.

Babies face higher risks of being very large or premature, having low blood glucose at birth and experiencing birth defects.

The trial was co-led by the University of Calgary.

Dr Denice Feig is the study’s co-principal investigator, an endocrinologist and clinician scientist at the Lunenfeld-Tanenbaum Research Institute, Sinai Health, and professor of medicine at the University of Toronto.

The researcher said: “Keeping blood glucose in the optimal range for pregnancy is exceptionally challenging when someone has Type 1 diabetes, despite their best efforts and the support of dedicated health care clinics.”

The study found the automated system led to three additional hours each day within the desired glucose range compared with standard delivery methods.

“This is very important because we have learned from other larger studies that every 72 minute per day increase, with glucose in the desired range during pregnancy, is associated with reduction in newborn complications,” says Dr Lois Donovan, study co-principal investigator, endocrinologist at Foothills Medical Centre in Calgary and Cumming School of Medicine researcher.

The automated system used was a Tandem t:slim X2 insulin pump with Control-IQ technology.

Participants using the system spent more time in healthy glucose ranges and less time above or below target. Improvements were immediate and continued through pregnancy across all 14 trial sites.

“We’ve known for a while that AID systems have achieved better glucose control with less diabetes management burden in non-pregnant people with Type 1 diabetes, but its use had not been well studied in pregnancy,” Donovan said.

“Most AIDs were not designed to achieve the narrow glucose range desired in pregnancy or to adapt quickly enough to the changing insulin requirement of pregnancy.”

The trial involved clinics in Calgary, Toronto, Vancouver, Quebec City, London (Ontario), Winnipeg, Halifax, as well as Canberra, Melbourne and Sydney.

“This finding will help inform people who are pregnant or planning pregnancy regarding the benefits of this AID system, which can help them achieve better glucose levels in pregnancy and hopefully better pregnancy outcomes” said Feig.

Pregnancy

Women with pre-eclampsia at increased risk of chronic kidney disease, study finds

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Women who develop pre-eclampsia face a higher risk of chronic kidney disease and high blood pressure later in life, new research suggests.

The amount of protein found in the urine during pregnancy may help identify those at greatest risk of developing long-term health problems.

Pre-eclampsia usually involves high blood pressure and increased protein in the urine. Some women also experience severe headaches and changes to their vision.

The condition cannot be treated during pregnancy and, in some cases, labour must be induced early to protect both the woman and baby.

The study found that the condition may be linked to longer-term health problems.

Anne Høy Seemann Vestergaard, a medical doctor and PhD at the department of clinical medicine at Aarhus University, said: “What we can see is a clear association between pre-eclampsia and the development of high blood pressure, chronic kidney disease and cardiovascular disease later in life.”

The researchers found that the amount of protein passed in the urine during pregnancy was linked to the risk of developing chronic conditions after giving birth.

Protein in the urine can indicate that the kidneys are not filtering blood normally.

Vestergaard said: “The most surprising finding was how clearly the amount of protein in the urine during pre-eclampsia was linked to the risk of later high blood pressure and chronic kidney disease. Women with moderate to severe protein excretion had a higher risk of both conditions compared with women with low or no protein excretion.”

Among women with pre-eclampsia and moderate to severe levels of protein in the urine, around one in 20 developed chronic kidney disease within 10 years and around one in six developed high blood pressure.

Most women in the study did not develop long-term complications, but the researchers said the increased risk should still be taken seriously because the potential effects can be severe.

Vestergaard said: “At first glance, this may sound like a low number, but it represents a markedly increased risk when the groups are compared. In the group with pre-eclampsia and high levels of protein in the urine, around 1 in 20 women developed chronic kidney disease within ten years, including early stages of the disease, compared with around 1 in 100 in the group with lower or no protein excretion.”

She added: “That is a considerable number in light of the fact that chronic kidney disease is a potentially serious condition that can progress to kidney failure if isn’t diagnosed early.”

The findings suggest women who experience pre-eclampsia may benefit from more systematic monitoring after pregnancy.

Vestergaard said: “Our study suggests that these women may benefit from monitoring of blood pressure and kidney function after pregnancy.”

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Pregnant women may reduce key health risk through more light exercise, study finds

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Light exercise and less sitting may reduce pregnant women’s risk of serious blood pressure complications, according to a new study.

Researchers have proposed a daily activity and sleep guide that they say was linked to a nearly 30 per cent lower risk of hypertensive disorders of pregnancy.

The suggested pattern includes fewer than eight hours of sedentary time, at least seven hours of light physical activity, around 22 minutes of more intense activity and nearly nine hours of sleep.

The University of Iowa-led study examined the daily behaviours of 470 pregnant women across all stages of pregnancy.

Participants wore monitors that measured physical activity over 24-hour periods and recorded how long they spent asleep.

Hypertensive disorders of pregnancy include chronic high blood pressure, gestational hypertension and pre-eclampsia.

Gestational hypertension is high blood pressure that develops during pregnancy, while pre-eclampsia is a potentially serious condition involving high blood pressure and signs that organs may be affected.

Sedentary behaviour means being mostly inactive, such as sitting or lying down.

Light physical activity can include casual walking, moving around the home or standing.

Moderate to vigorous activity includes movement such as brisk walking, where breathing and heart rate increase.

Kara Whitaker, associate professor in the department of health, sport, and human physiology at Iowa and corresponding author of the study, said: “We are identifying the optimal composition of movement behaviours across the day associated with the lowest risk of developing HDP and the most improved health outcomes.

“This blueprint holds for each and every trimester of pregnancy.”

Study participants were enrolled at sites in Iowa City, Pittsburgh and Morgantown, West Virginia.

The women wore activity and sleep monitors for at least one week during each trimester of pregnancy.

Four in five participants were non-Hispanic white and nearly a quarter lived in rural areas.

The data showed a steep rise in risk among pregnant women who were sedentary for more than 10 hours a day.

Women who increased light physical activity to at least four hours a day reduced their risk of hypertensive disorders of pregnancy to 15 per cent from 30 per cent.

Whitaker said: “Just moving around more seems to have significant health benefits.

“And I think it also may be a more feasible target for women who are pregnant who are not exercising regularly.”

The researchers said they were surprised that longer durations of moderate to vigorous physical activity did not appear to provide additional benefit.

Sleep beyond a certain duration also did not appear to bring major further benefits.

Whitaker said: “Through this study, we are providing evidence that reducing sedentary behaviour and engaging in light physical activity are important, and maybe more important, when it comes to pregnancy and health.”

The findings may be relevant beyond pregnancy because clinical research has shown that women who develop hypertensive disorders of pregnancy are more than twice as likely to develop heart disease later in life.

Cardiovascular disease includes conditions affecting the heart and blood vessels, such as heart disease and stroke.

Whitaker said: “We know that cardiovascular disease is the number one killer of women, and if we can intervene in pregnancy and prevent women from developing a hypertensive disorder of pregnancy, we are putting them on a better trajectory, away from cardiovascular disease and toward more optimal cardiovascular health.”

The study was published online on June 10.

A second study, published online on May 27, looked more closely at the ratio and type of sedentary behaviour and light physical activity linked to a lower risk of hypertensive disorders of pregnancy.

Whitaker is a lead co-author on that study.

Co-authors in the June 10 study include Alex Crisp, Jaemyung Kim, Karina Smith, Donna Santillan, Mark Santillan and Bridget Zimmerman, from Iowa; Jacob Gallagher, from Iowa State University; Melissa Jones, from Oakland University in Michigan; Bethany Barone Gibbs, Katrina Wilhite, Alexis Thrower and Iqra Sheikh, from West Virginia University; and Sabera Rahman, Janet Catov, Christopher Kline and Maisa Feghali, from the University of Pittsburgh.

The National Institutes of Health, the University of Iowa Institute for Clinical and Translational Science, the University of Pittsburgh Clinical and Translational Science Institute and the West Virginia Clinical and Translational Science Institute funded the research.

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£50m initiative aims to tackle disparities in maternal healthcare

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A £50m maternity consortium will bring together UK clinicians, researchers and communities to tackle the most critical gaps in maternal care.

Funding from the National Institute for Health and Care Research has established the NIHR Inequalities Challenge: Maternity Disparities Consortium under the leadership of the University of Birmingham and Newcastle University.

Higher education bodies, NHS organisations, community groups and voluntary organisations from across the UK will work together through the programme.

The NIHR has committed £50m over five years to support research led by clinicians, researchers and communities across the consortium.

Professor Joht Singh Chandan, consortium co-lead for research at the University of Birmingham, said: “National attention on maternity safety and equity has never been greater, but ambition must now be matched by evidence and implementation.

“Through this consortium, we will work across the UK to understand what works, for whom and in what contexts, and to ensure that research leads to practical changes in care for the women, babies and families who need them most.”

The launch comes at a pivotal moment for UK maternity care, with growing national attention on improving safety, equity and women’s experiences of care.

The government’s renewed Women’s Health Strategy highlights the need to improve care before and between pregnancies for underserved communities.

Against that backdrop, the consortium will generate the evidence, interventions and research capacity needed to help turn national ambition into practical improvements for women, babies and families.

University of Birmingham is leading work to improve maternity care pathways across the antenatal, intrapartum and postnatal periods.

Antenatal care covers pregnancy before labour, while intrapartum care refers to care during labour and birth.

The consortium will examine how women and families can be better supported before pregnancy and between pregnancies.

This includes improving access to advice and care that can help people prepare for pregnancy, manage existing health conditions and reduce risks before they build up.

Other research will focus on improving care during pregnancy, birth and the early weeks after birth.

This will include work on major causes of poor maternal health, such as high blood pressure, diabetes in pregnancy, obesity, perinatal mental health and complications during recovery after birth.

Professor Judith Rankin OBE, consortium co-lead for research and capacity development at Newcastle University, said: “This funding represents a critical opportunity to make the step change we need to improve outcomes for women and their babies.

“Alongside the research, the Consortium will be investing in tomorrow’s research leaders today to ensure we have the capacity to deliver on improving pregnancy outcomes, access to, and experience of, care.”

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