Pregnancy outcomes of women with Type 2 and gestational diabetes mellitus (GDM): specific focus on client engagement with health professionals, diagnosis of GDM and supplementation with omega 3 fatty acids
Maternal nutrition is essential to the well being of mother and baby during pregnancy and beyond. It is necessary for effective placental accretion, foetal growth and development and optimal pregnancy outcomes. Adequate nutrition becomes even more critical when pregnancies are complicated with diabetes of any type which includes type 2 diabetes mellitus (T2 DM) and gestational diabetes mellitus (GDM). Complementary to other lifestyle factors, nutrition forms the cornerstone for achieving euglycemia to reduce potential maternal and foetal risks associated with diabetes in pregnancy such as macrosomia, hypertensive disorders and preterm birth. T2 DM and GDM are characterised by insulin resistance which affects effective beta cells function in the secretion and synthesis of insulin. Additionally, reduced levels of arachidonic acids (AA) (omega 6 fatty acids) and docosahexaenoic acids (DHA) (omega 3 fatty acids) have been found in maternal red blood cells in pregnancies complicated with diabetes. AA and DHA cannot be produced by the body and must be ingested by the mother. Foetal demands for these fatty acids are high and these are transferred by placental selection from maternal to placental circulation. It is reported that diabetes impairs the activity of delta-6 and delta-5 desaturases which are enzymes necessary for the synthesis of AA & DHA. Recent studies have reported significantly lower levels of AA & DHA in the red blood cells of pregnant women with GDM and T2 DM, resulting in a depletion in placental uptake and transfer of these fatty acids to the foetus and adequate supply for the mother, which if remains untreated, may have adverse impact on maternal, foetal and neonatal health in the short- and long-term. Therefore, women in these high risk groups need to effectively engage with health care professionals (HCPs) involved in their care and the services offered to them. Insulin therapy and supplementation with these essential fatty acids may correct this depletion. However, the impact on pregnancy outcome remains unknown. Newham is one of the most deprived boroughs of London and has a high prevalence and incidence of diabetes. Therefore, by evaluating the pregnancy outcomes of women with T2 DM and GDM after supplementation with essential fatty acids (EFAs), the local service needs would be better understood, and vital answers would be provided to optimise the pregnancy outcomes for this client-group which already has complex health needs.
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