Pregnancy and diabetes
Pregnancy and diabetes: reducing
complications with technology
Women with type 1 or type 2 diabetes often have difficulty getting pregnant, due to complications from the disease, being obese or seriously underweight,
or having conditions like polycystic ovary syndrome. Once pregnant, they
face the challenges of having a safe pregnancy and delivering a healthy baby.
Recent advances in diabetes technology, including continuous glucose
monitoring (CGM) and most recently hybrid closed-loop (HCL) insulin delivery
systems can help women meet their pregnancy glucose targets and achieve
significantly better health outcomes for themselves and their infant.
Vitamin D during pregnancy may boost
children’s bone health
Taking extra vitamin D during pregnancy may improve the bone health of children, according
to a new study. Bone density scans revealed that children of mothers who took Vitamin D
supplements during pregnancy had higher levels of calcium and other minerals in their bones by mid-childhood,
making their bones stronger and less likely to break.
The researchers from the University of Southampton found that the benefits of Vitamin D
supplements could be seen up to seven years after birth.
The findings are published in The American Journal of Clinical Nutrition and highlight the
importance of vitamin D supplementation in pregnancy as a public health strategy.
In 2009, the researchers launched the MAVIDOS study and recruited over 1,000 women across
three UK hospitals in Southampton, Sheffield, and Oxford. The women were randomly assigned
to one of two groups. Starting at 14 weeks gestation, one group took a daily Vitamin D
supplement of 1,000 International Units, whilst the second group received a daily placebo tablet
throughout the rest of their pregnancies. Both the healthcare professionals and the women
were unaware of which group participants were assigned to.
The group’s previous research found that bone mass was greater at age four in children whose
mothers had taken Vitamin D supplements during pregnancy. The researchers followed up with
454 of the original cohort of children and conducted bone density measurements between the
ages of six and seven.
Dr Rebecca Moon, NIHR Clinical Lecturer in Child Health at the University of Southampton,
who led the study, said: ‘Our findings show that the benefits of vitamin D supplementation during
pregnancy persists into mid-childhood. This early intervention represents an important public
health strategy. It strengthens children’s bones and reduces the risk of conditions like
osteoporosis and fractures in later life.’
The researchers involved in the MAVIDOS study have been working to understand the
mechanisms linking maternal vitamin D supplementation with offspring bone mass. In 2018, they
successfully demonstrated that vitamin D supplementation led to changes in the activity of
genes forming part of the vitamin D pathway.
The group’s latest findings reveal that improvements in bone density continue further into
childhood than previously understood and strengthen support for the UK’s public health strategy,
which now routinely advises all pregnant women to take vitamin D supplements.
Is It Safe to Take Antidepressants
During Pregnancy?
Here's what to know about safely managing medication during
pregnancy. Pregnancy can feel like a magical experience filled with joy and
anticipation. However, for many women, it becomes a dark and lonely time
overshadowed by stress, fear, and sadness. Rapid hormonal changes occur,
which contribute to mood swings, and estrogen levels rise to their highest peak of
any time in a woman’s lifecycle.
Depression During Pregnancy
Depression is a serious illness that can devastate people’s lives. It can steal the ability to
experience joy and lead people to feel worthless and hopeless. It can lead to insomnia, poor
appetite, inability to concentrate, lethargy, and, in extreme cases, suicidal thoughts. Women
especially are afflicted by depression, affecting about one in five within the course of their
lifetimes. When depression intersects with pregnancy, which occurs in about 7 percent of
women, the effects can be crushing. Pregnant women suffering from depression are at risk for
poor compliance with prenatal care, inadequate nutrition, and lack of self-care. They are more
likely to turn to alcohol, cigarettes, or drugs in an attempt to cope with these negative emotions
(Guo et al., The 2018; Alwa et al., 2007).
Consequences of Antenatal Depression on the
Developing Baby
The consequences of depression during pregnancy, or antenatal depression, can
wreak havoc on a woman and her family. These women may be plagued by
constant worrying and feel overwhelmed. Untreated depression raises the risks of
premature delivery and low birth weight of the newborn. Dr. Catherine Birndorf, a
reproductive psychiatrist and co-founder and medical director of The Motherhood
Center, explains that antenatal depression is one of the leading risk factors for the
development of postpartum depression. Contrary to common perceptions, pregnancy
does not protect against depression, and antenatal depression is likely to worsen
after birth if untreated (C. Birndorf, personal communication, October 30, 2024). This
is consistent with studies that have shown that almost 40 percent of women with
antenatal depression go on to develop postpartum depression (Underwood et al.,
2016).
How to Treat Antenatal Depression
Many reproductive psychiatry specialists now believe that the best option for treating
moderate to severe depression during pregnancy includes the use of
antidepressant medications along with non-pharmacological approaches, such as therapy and
exercise. Dr. Birndorf—co-author of What No One Tells You: A Guide to Your
Emotions from Pregnancy to Motherhood—specializes in the treatment of pregnant
and postpartum women and empowers them to make informed choices regarding
the use of antidepressants. She emphasizes that the best thing for a pregnant
woman and her growing baby is maternal wellness and some women require
medication to be well. Untreated depression poses significant risks, including
becoming unable to work, function, or care for one's children (C. Birndorf, personal
communication, October 30, 2024).
My Experience Treating Women During Pregnancy
As a specialist in psychopharmacology and reproductive psychiatry, I have treated
many women taking antidepressant medications during their pregnancies. We often
engage in multiple discussions about the risks and benefits of medication use when
they are planning to conceive. For patients with a significant history of depression—
those who have experienced severe or multiple episodes—many choose to
continue their antidepressant medication at least until pregnancy is confirmed. At that
point, we may consider tapering the medication under close supervision. If signs of
relapse appears, we generally restart the medication promptly.
I encourage my patients to proactively engage in non-pharmacological approaches,
such as therapy and regular exercise, to support their mental health. Some patients
decide to remain on their antidepressant throughout pregnancy, recognizing that the
risks of discontinuing medication could be catastrophic for them. Others have had
positive experiences with antidepressant use during previous pregnancies and opt to
stay on their medication.
In my experience, I have never encountered a woman who regretted taking an
antidepressant during pregnancy. However, I have treated women who suffered
from antenatal depression and felt severely traumatized by the experience.
Medication Use During Pregnancy Is Common
About 80 percent of pregnant women report taking at least one medication during
pregnancy (U.S. Food & Drug Administration, 2023). Some have underlying medical
conditions such as diabetes, Crohn’s disease, or lupus and require maintenance
medications. Antibiotics for an infection or steroids for asthma may be necessary.
New illnesses may develop, such as gestational diabetes, hypothyroidism, or high
blood pressure, that require treatment. In addition to medication exposure during
pregnancy, many women use alcohol or other substances in the early weeks of
pregnancy before realizing they are pregnant.
Research on Antidepressants During Pregnancy
Randomized controlled studies are not possible during pregnancy for ethical reasons.
However, data is collected through Pregnancy Exposure Registries and outcome
measures have been overall encouraging. Most studies found that early pregnancy
exposure to selective serotonin reuptake inhibitors (SSRIs), such as Prozac and
Zoloft was not associated with a significant increase in risks of congenital heart
defects or of most other categories of congenital disabilities (Alwan et al., 2007;
Huybrechts et al., 2014). Some conflicting data exists regarding whether there is a
slight increase in congenital disabilities with SSRI use; however, when adverse
effects have occurred, it is unclear whether they are attributable to SSRI use,
underlying depression, or other variables (Alwan et al., 2007; Anderson et al., 2020). For
example, patients with depression are more likely to use alcohol, cigarettes, and
drugs, which are potential risk factors for adverse birth outcomes (Huybrechts et al.,
2014).
A recent study from Brigham and Women’s Hospital and Harvard Medical School
evaluated over 145,000 pregnancies with antidepressant exposure and assessed
neurodevelopmental outcomes in children (Suarez et al., 2022). Their findings
suggested that antidepressant exposure during pregnancy was not associated with
autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning
disorders, intellectual disabilities, or behavioral disorders (Suarez et al., 2022).
Barriers to Antenatal Depression Treatment
Dr. Birndorf explains that one of the most significant barriers to antenatal depression
treatment relates to myths around what pregnancy should be, such as the notion
that everybody else is glowing and that the woman is somehow defective or weak
or
broken because she has this problem (C. Birndorf, personal communication,
October 30, 2024). Feelings of shame or guilt may prevent women from disclosing
their suffering and lead to avoidance of treatment. Other barriers include a lack of
awareness that antidepressants can be taken during pregnancy, as well as poor
access to specialized treatment.
Removing the Stigma
The wall of silence around antenatal depression is starting to crumble. Celebrities
such as Britany Spears, in her memoir The Woman In Me, wrote about her
experience of depression during pregnancy, including loss of pleasure and feeling
angry. Actress Shay Mitchell described her experience of crippling depression,
anxiety, and isolation during her pregnancy (Good Morning America, 2019). Actress
and author Jenny Mollen wrote about the darkness and fear she experienced during
pregnancy (Global News, 2017). These brave women help to remove stigma and
encourage those suffering from antenatal depression to seek support and make
informed decisions about taking antidepressants during pregnancy.
Non-pharmacological Treatment of Antenatal Depression
Non-pharmacological management strategies such as therapy, exercise, and
meditation should be maximized to treat depression during pregnancy. However, for
moderate to severe depression, antidepressants may become necessary for
adequate symptom relief. Proper medical treatment is critical for the health and
well-being of the expectant mom and the developing child.
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