Disputation: Alexandra Goldberg
2025-09-12 9:00 Add to iCal
Hybrid Plats: Föreläsningssalen C1 87, Karolinska Universitetssjukhuset Online: Anslut till eventet
Type 1 diabetes during pregnancy, birth and breastfeeding
Institutionen för klinisk forskning och utbildning, Södersjukhuset
Opponent
Professor Marie Berg,
Institutionen för vårdvetenskap och hälsa,
Göteborgs universitet
Betygsnämnd
Docent Michael Alvarsson,
Institutionen för molekylär medicin och kirurgi,
Karolinska Institutet
Professor Christine Rubertsson,
Institutionen för hälsovetenskaper,
Lunds universitet
Professor Renée Flacking,
Institutionen för hälsa och välfärd,
Högskolan Dalarna
Handledare
Eva Wiberg-Itzel,
Institutionen för klinisk forskning och utbildning Södersjukhuset,
Karolinska Institutet
Cecilia Ekéus,
Institutionen för kvinnors och barns hälsa,
Uppsala universitet
Carina Ursing,
Institutionen för klinisk forskning och utbildning Södersjukhuset,
Karolinska Institutet
Joanna Tingström,
Institutionen för klinisk forskning och utbildning Södersjukhuset,
Karolinska Institutet
Läs mer
• Background
Managing Type 1 diabetes (T1D) during pregnancy remains a clinical challenge due to the increased risks of complications for both mother and child, making the well-documented benefits of breastfeeding especially important in this context.
To reduce the risk of complications, evidence-based care is essential throughout the perinatal period. In Sweden, perinatal care for pregnant women with T1D is managed by decentralised, hospital-specific guidelines without evaluation of the perinatal outcomes over the past two decades.
Breastfeeding also plays a vital role in perinatal care; therefore, antenatal colostrum expression is recommended for women with T1D to support the early provision of exclusive colostrum. However, the composition of antenatal colostrum in women with T1D has not been previously explored.
• Aim
This thesis aims to improve care for pregnant women with T1D and their newborns by studying care provision in terms of guidelines, colostrum composition, and maternal and neonatal outcomes.
• Method
Study 1 was a descriptive study aimed at comparing all the Swedish guidelines for the management of T1D during pregnancy and birth in terms of the degree of consensus among them. The second aim was to measure adherence to three of these guidelines in use at four hospitals and to describe the pregnancy and labour outcomes in relation to the level of adherence.
Study 2 was a prospective cohort study that aimed to investigate and compare the macronutrient content in colostrum collected from women with and without T1D during gestational weeks 36 to 40 and postpartum days one to five. The study also aimed to compare the colostrum contents between women with and without T1D. A secondary aim was to compare the colostrum content from postpartum day one with colostrum from all the other timepoints and with formula.
Study 3 was a retrospective cohort study using the Swedish Medical Birth Register to explore the odds of adverse neonatal outcomes in newborns of mothers with T1D compared to those of mothers without T1D during the years 2010-2022.
Study 4 was a retrospective cohort study that utilized the Swedish Medical Birth Register to explore the odds of adverse maternal outcomes in women with T1D compared to women without T1D during the years 2010-2022.
• Results
No complete consensus was identified across the 30 hospital guidelines. Adherence to the guidelines with a rate of 270% was found to be low. A high adherence to the birth guidelines was significantly more common when the birth was induced.
When pregnancy or birth guidelines were followed with low adherence non-instrumental vaginal births occurred more often.
The colostrum content, specifically in terms of fat, carbohydrates, protein, and kilocalories, varied between the time points. Colostrum differed in protein in antenatal colostrum between women with and without T1D. Colostrum from postpartum day one was more similar to antenatal colostrum than colostrum from days two to five, and compared with formula.
Neonates born to mothers with T1D had significantly increased odds of adverse neonatal outcomes, such as stillbirth, congenital malformations, premature birth, being born large for gestational age, and neonatal death.
Women with T1D were generally taller and more often classified as overweight or obese, with higher rates of chronic kidney disease, chronic hypertension, smoking, and having been born in a Nordic country compared to women without T1D. T1D was significantly associated with increased odds of adverse maternal outcomes such as caesarean section, shoulder dystocia, postpartum haemorrhage, and endometritis.
• Conclusion
Developing an evidence-based national guideline for preconception and perinatal care with high adherence, incorporating a recommendation to supplement fed newborns with antenatal colostrum, could help improve health outcomes for pregnant women with T1D and their newborns.
List of scientific papers
• Goldberg A, Ursing C, Ekéus C, Wiberg-Itzel E. Swedish guidelines for type 1 diabetes and pregnancy outcomes: A nationwide descriptive study of consensus and adherence. Prim Care Diabetes. 2021;15(6):1040-51.
• Goldberg A, Pettersson H, Ekéus C, Ursing C, Wiberg-Itzel E, Tingström J. Comparison Between Antenatal and Postnatal Colostrum From Women With and Without Type 1 Diabetes. J Hum Lact. 2025;41(2):254-62.
• III. Goldberg A, Wiberg-Itzel E, Tingström J, Ekeus C. Neonatal Outcomes Among Neonates of Women With and Without Type 1 Diabetes in Sweden From 2010 to 2022. Acta Paediatr. 2025.
https://doi.org/10.1111/apa.70230
• Goldberg A, Wiberg-Itzel E, Tingström J, Ekeus C. Maternal outcomes among women with and without Type 1 Diabetes in Sweden. [Submitted]
History
2025-08-14 – First online date, Posted date
Related Materials
- 1.
PMID – Has part https://pubmed.ncbi.nlm.nih.gov/34556439
Swedish guidelines for type 1 diabetes and pregnancy outcomes: A nationwide descriptive study of consensus and adherence
- PMID: 34556439
- DOI: 10.1016/j.pcd.2021.08.003
Free article
Abstract
Aims: Type 1 diabetes (DM1) during pregnancy and labor is associated with an increased risk of maternal and fetal complications. Evidence-based care is therefore provided in accordance with guidelines. In this study, we aimed to compare all the Swedish guidelines for DM1 during pregnancy and labor in terms of the variables emphasized in the national guidelines from the US and from England and Wales. The second aim was to measure adherence to local guidelines at the four hospitals in Stockholm that cared for pregnant women with DM1 during 2016 and to describe the pregnancy and labor outcomes.
Methods: All the Swedish guidelines for DM1 during pregnancy and labor were reviewed on 31 variables. The medical records of 114 women were reviewed according to whether ≥70% of 22 variables in the guidelines were followed.
Results: No consensus was found in the Swedish guidelines for any of the 31 variables. Some guidelines were contradictory. The pregnancy guidelines were followed in 17.5% of the medical records, 18.4% followed the labor guidelines, and 5.3% followed both guidelines. The onset of labor, mode of delivery and HbA1c in the third trimester varied significantly, depending on the adherence to guidelines.
Conclusions: The Swedish guidelines for DM1 during pregnancy and labor lack both consensus and adherence. A national guideline on DM1 during pregnancy and childbirth with high adherence could improve care for pregnant Swedish women with DM1 and their fetuses.
PMID – Has part https://pubmed.ncbi.nlm.nih.gov/40071794
PMID – Has part https://pubmed.ncbi.nlm.nih.gov/40665497
Nyhetsinfo
www red DiabetologNytt