Obstetrics: Insulin sensitivity during pregnancy and post partum

The aim of the study is to define insulin requirement during pregnancy and to identify the rapid changes in insulin sensitivity around parturition and the first 6 months post partum. Such knowledge would be clinically useful and markedly improve insulin treatment before and after parturition for women with T1DM and serve to identify the best possible timing of testing women with GDM for the development of T2DM post partum. Furthermore we wish to explore the effects of breastfeeding on glucose tolerance the first year after giving birth in women with T1DM.
Method:
Following studies are planned:
1. Insulin resistance throughout pregnancy assessed by insulin requirement in pregnant T1DM women. Retrospective cohort study of women with T1DM with a singleton pregnancy, approximately 600 patients.
2. Hyperinsulinaemic euglycaemic clamp in women before, immediately after delivery and 6 months post partum. We will compare 20 women with GDM in late pregnancy, day 15 post partum and 6 months post partum with 20 normal women investigated at the same time points.
3. Insulin requirement in women with insulin dependent diabetes post partum. Does lactation change insulin sensitivity? Prospective study of the insulin requirement estimated by blood sample (HbA1c) and questionnaire at 1, 3, 6 and 12 months post partum in women with insulin dependent diabetes.
Perspectives
Diabetes is a common condition with important implications for pregnancy outcome and long-term morbidity for mother and offspring. Accordingly, tailoring the best treatment is expected to have beneficial consequences both for the pregnant women and the future generation.