Type 1 diabetic women carrying twins require more insulin than single pregnancy

Type 1 diabetic women need higher doses of insulin when they are pregnant with twins compared to when they are pregnant with one child, according to a news report on Daily RX.

The article cites a recent study by the Center for Pregnant Women with Diabetes in Copenhagen, Denmark that followed 15 women pregnant with twins and 108 women pregnant with a single child.

All subjects had type 1 diabetes and were checked at 8, 14, 21, 27 and 33 gestational weeks for insulin requirements and HbA1c levels, which measure average blood glucose over a three-month period.

The study found that women with type 1 diabetes carrying twins needed 103 percent more insulin at 33 weeks gestation compared to before pregnancy. Women with type 1 diabetes carrying one child needed 71 percent more insulin than before pregnancy.

According to the article, the weekly increase in insulin dose between 14 and 27 weeks was doubled compared to single pregnancies.

Pregnancy and diabetes
Babies born to women with diabetes have a higher risk for birth defects, according to the American Diabetes Association. High blood glucose levels and ketones pass through the placenta to the baby.

High blood glucose levels during the first trimester can affect organ formation, a process that is completed by seven weeks after the last period. Women are at a higher risk for miscarriage and birth defects during this time.

Other risks to both mother and child of high blood glucose levels during pregnancy include premature delivery, miscarriage, birth defects, having a large baby, low blood glucose at birth, prolonged jaundice, and respiratory distress syndrome.

For the mother, high blood glucose levels can worsen diabetic eye and kidney problems, cause urinary bladder and vaginal infections, make delivery difficult or necessitate a cesarean section, or cause preeclampsia.

The American Diabetes Association recommends that women with diabetes plan their pregnancies so that their blood glucose levels are under control three to six months before getting pregnant. Excellent control of blood glucose is also crucial during pregnancy.

Healthy lifestyle habits are important to help women with diabetes reduce the risk of complications for both mother and baby. Diabetic women should maintain an HbA1c level of less than 7 percent, a healthy body weight, and healthy diet and regular exercise.

Women should also seek a pre-pregnancy exam, according to the American Diabetes Association. This includes measuring HbA1c levels, assessing complications like high blood pressure, heart disease, and kidney, nerve and eye damage. The exam may also check thyroid function in women with type 1 diabetes.

Sources: Daily Rx, Diabetes Care, American Diabetes Association