Six and a half million American women of reproductive age are living with diabetes. Another 400,000 American women develop gestational diabetes during their pregnancies each year. Managing diabetes during pregnancy requires an incredible amount of work from patients and their care team. But even with dedicated management, most diabetic pregnancies encounter complications.
Despite the high number of women who must endure pregnancies with diabetes and the high risks that come with such an endeavor, there is a surprising lack of mobile health, healthcare, and integrated diabetes device applications that are made to or include special functionality to help women better manage their diabetes during pregnancy.
This lack of pregnancy-centric software is yet another unfortunate indication that the unique needs of women are too often overlooked in the healthcare world. But this void also represents an opportunity for the development of new software dedicated to helping women with pre-existing diabetes and those who develop gestational diabetes to better manage their blood sugar during pregnancy to help guarantee more positive outcomes for mother and child.
Risks of Diabetes in Pregnancy
High blood glucose during pregnancy has a long list of known deleterious effects on the growing fetus, including:
- Large for gestational age and other growth abnormalities
- Premature birth
- Neonatal hypoglycemia
- Hyperbilirubinemia
- Shoulder dystocia
- Stillbirth
There are also increased risks to the mother during pregnancy, including:
- Preeclampsia
- Gestational hypertension
- Iatrogenic preterm birth
- Higher rates of cesarean birth
- Worsening of retinopathy and possible loss of vision
Furthermore, about 50% of women who develop gestational diabetes go on to be diagnosed with type 2 diabetes later in life.
Managing Diabetes through Pregnancy
Comprehensive blood sugar management during pregnancy has been shown to significantly reduce diabetes-related risks for both mother and baby. Due to the complexities of carbohydrate metabolism and insulin sensitivity during pregnancy, however, managing blood sugars requires a much more specific and aggressive approach in gravitas than it does in the typical patient.
Hormones produced by the placenta reduce the effectiveness of insulin in the mother’s body. This causes the mother’s insulin needs to increase throughout the pregnancy, especially during the final trimester. Further complicating insulin dosing is the natural weight gain and reduction in activity that comes with the latter end of pregnancy.
Pregnant women are also at an increased risk of hypoglycemia during times of intentional or unintentional fasting. This is especially dangerous for women with diabetes as the typical signs of low blood sugar tend to be less noticeable during pregnancy. Further complicating this issue is the fact that ADA guidelines suggest lower target blood sugars for pregnant women to help reduce risks to the fetus.
To better manage blood sugars against these obstacles, more endocrinologists are switching their type 1 and type 2 patients to insulin pumps and continuous glucose monitors (CGMs) during their pregnancies. About 74% of pregnant diabetic women use insulin pumps compared to only about 25% of the general diabetic community. CGMs are also becoming more popular for use during pregnancy with 36% using these monitors compared to only about 15% in the larger community.
Developing Software for Diabetes and Pregnancy
Despite the increasing use of available technology, blood sugar management among pregnant women with diabetes is still far from optimal. Only about 70% of women achieve an A1c of 6.5 or below during pregnancy. For those that do hit this important mark, it is most often achieved during the last trimester after high blood sugar is likely to have already caused problems for the fetus.
Software developed to help women gain better control over their blood sugars both before and during pregnancy could have a significant positive impact on the health of these women and their children.
There is a need for this kind of software in almost every diabetes-pregnancy niche from healthcare worker applications and mobile phone apps, to the software that goes into the development of integrated automated insulin dosing (AID) systems.
Studies have shown that higher mean glucose levels are largely driven by suboptimal nocturnal blood sugars. A personal health app with customizable nighttime alarms would help remind pregnant women to get up and check their levels during these particularly vulnerable times. Pregnancy-specific software for AID programs could be set to lower targets during the night to help achieve overall lower A1c levels.
The burden of managing blood sugars during diabetes is compounded by the extra endocrinology appointments, check-ups with specialists, and additional stress and ultrasound tests recommended for diabetic pregnancies. Software that allows for the real-time upload of data from CGMs, pumps, pens, and meters could reduce the need for in-person appointments by virtually connecting patient and doctor and providing all necessary data to make dose-change decisions.
Mobile software, especially, has the potential to increase positive outcomes in minority communities where risks of preterm birth and maternal mortality are already higher. The use of smartphones has been shown to be consistently high across all ethnic groups and socio-economic classes. In addition to appointment and medication reminders, targets set based on current diabetic pregnancy standards, and data sharing between devices, these apps could also provide important education on how insulin sensitivity changes throughout pregnancy, activity recommendations specific to the person’s type of diabetes and stage of gestation, and more.
Considering the inarguable need for better diabetes care during pregnancy and the vast number of applications for software that could help meet this need, it is surprising that there aren’t more companies pursuing the pregnancy-diabetes niche. Doing so would no doubt bring immense opportunity, but also provide pregnant women with what they want most: tools to help guarantee the health of their child.