Hadden Lecture focuses on management of diabetes in pregnancy

Irish Endocrine Society, Annual Conference, 27 November 2020

This year’s IES Hadden Lecture was delivered by Prof Helen Murphy, Professor of Medicine (Diabetes and Antenatal Care) at the University of East Anglia and Professor of Women’s Health at Kings College London, on the topic of ‘Management of Diabetes Pregnancy in 2020 and beyond’.

Irish-born Prof Murphy, who received her undergraduate medical degree from University College Dublin and carried out her early training in Dublin, runs a diabetes pregnancy research programme, which aims to improve the glucose control and infant health outcomes of pregnant women with diabetes.

Her research interests include improving access to preconception care, developing novel continuous glucose monitoring and artificial pancreas technologies and the role of maternal dietary intake in gestational diabetes, and her work is funded by the National Institute for Health Research (NIHR), Juvenile Diabetes Research Foundation (JDRF), Diabetes UK, Diabetes Research and Wellness Foundation (DRWF), and European Association for the Study of Diabetes (EASD).

Prof Murphy outlined her fascinating career journey to date and some of her extensive research work, including the findings of research associated with the work of the East Anglia Study Group for Improving Pregnancy Outcomes in Women with Diabetes (EASIPOD) programme.

The EASIPOD programme highlighted the negative burden that diabetes places on pregnancy, increasing the risk of still birth and neonatal death (6.5-10 per cent), early pregnancy loss (20 per cent), preterm delivery (40 per cent), neonatal care admission (40 per cent), and overweight/obese infants (50 per cent).

“When we started looking at this I was shocked at the high prevalence of potentially modifiable birth defects.”

Prof Murphy and colleagues developed and evaluated a community-based pre-pregnancy care (PPC) programme with the aim of improving pregnancy preparation in all women with pre-gestational diabetes, which was associated with clinically relevant improvements in pregnancy preparation in women with type 2 diabetes.

She told the meeting that sufficient consideration is often not given to the risks of type 2 diabetes in pregnancy compared to type 1, despite the complication rates, and poor glucose target rates.

Looking at the challenges facing maternity services currently, Prof Murphy voiced concern about the impact of Covid-19 on routine pregnancy care and increased incidence of negative outcomes.

“What we have sadly seen are increased rates of pre-eclampsia. I’ve seen more women in the last three-to-six months than over my entire career with more severe pre-eclampsia and there has been a rise in stillbirths. So it is absolutely vital, particularly in this year when our focus has been on the Black Lives Matters campaign, that we do everything we can to ensure that it is not just the educated affluent women who are able to access digital services….”

Prof Murphy also discussed the benefits of continuous glucose monitoring (CGM) for pregnant women with diabetes and its impact on improving glucose levels and associated complications.

“I think what CGM really does is help people understand the need to bolus their insulin in advance of eating.”

In recent months, following significant lobbying by the JDRF and partner organisations, the NHS in England began providing CGM to pregnant women with type 1 diabetes, after the initial rollout was delayed by Covid-19. NHS England aims to provide CGM to all pregnant women with diabetes by April 2021, which Prof Murphy said will help improve neonatal outcomes.