David McIntyre, MD, FRACP, describes lessons learned from the pandemic for ensuring appropriate continuation of care for pregnant patients with diabetes.
We need to be very careful in any future pandemic about putting limits or brakes on breastfeeding, said David McIntyre, MD, FRACP, a professor of medicine and an endocrinologist at the University of Queensland in Brisbane, Australia.
What are some lessons learned from COVID-19 when it comes to pregnant patients with diabetes?
I think that's a very important point. I hope that lessons are being learned. At the moment, I think everyone just has sort of COVID-19 fatigue and would just like to see the end of the current pandemic, which is obviously going to take a while because we're now experiencing what was predicted in terms of new variants developing, with more rapid spread patterns, and perhaps some degree of resistance to the vaccine immunity. I think that pregnant women are often not included in initial trials, which is probably reasonable—but they often are at risk. And particularly, we know that anything to do with severe respiratory disease carries an increased burden in pregnant women because of the pressure of the pregnant uterus on the abdomen and respiratory compromise due to some diaphragmatic splinting, etc. So pregnant women always need to breathe more effectively, even then outside of pregnancy, so that's certainly a risk for any respiratory virus.
Then we know that a number of other pandemics that have potentially come up, like Zika, have had specific transplacental effects and effects on babies' neurological development. I think the response very much depends on the pathogen. Fortunately, it seems with COVID-19, so called vertical transmission directly from mother to baby in utero, is very rare. There are some cases that look like they've been reasonably well documented.
The other point I would make is that, in the beginning of COVID-19, people were very cautious about recommending breastfeeding because of the risk of mother-infant transmission. Again, it appears that actual transmission through breast milk is extremely rare. It's really about respiratory protection. So the mother taking effective precautions and also protections, hand washing and all the routine things, wearing masks. I think, of course, breastfeeding has tremendous advantages, both for mother and baby. Those advantages are even more prominent if the mother has type 1, type 2, or gestational diabetes, both in terms of her diabetes risk and the baby's risk of developing obesity and diabetes.
I think we need to be very careful in any pandemic, any future situation about putting limits or brakes on breastfeeding, even with the best intention. That's perhaps something we need a more supportive approach to encouraging breastfeeding in the context of potential future infections or pandemics.
Can you discuss the important role technology plays in diabetes care?
I would just stress that there has been an improvement in the role, or the recognition of the role, of technology. Fortunately, we've had the availabilities of technologies such as flash glucose monitoring, continuous glucose monitoring. These we need to look at, I think, as alternatives. And certainly they've come to the fore in type 1 diabetes. Many people, or many systems, have been unwilling to fund them for type 2, and perhaps you could argue outside the context of this epidemic for type 2 and GDM [gestational diabetes mellitus], they maybe don't add that much value for most people. But it certainly gives us a way of remotely monitoring women's glycemia during pregnancy, which when people are socially isolated is very useful. I think we perhaps need to have our policymakers consider increased access toward technological solutions when some other solutions fall over, due to the sort of problems we've discussed