Submitter Withdrawn The Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2014

Managing pregnancy in Addison's and Type 1 diabetes - a tough balancing act (#297)

Sze Mei Yong 1 , Helena Teede 1
  1. Monash Health, Melbourne, VIC, Australia

There has only been one case report in 2004 on managing pregnancy in Addison's and Type 1 Diabetes. 

Mrs CJ is a 30 year old midwife with Type 1 Diabetes and Addison’s disease. She is prone to hypoglycaemia and her HbA1C is usually maintained between 7 to 8% on glargine and aspart. She also used DAPHNE to control her diabetes and did not want to use a pump. 

When she fell pregnant, she developed significant nausea and hypoglycaemia especially during her 1st trimester. Her HbA1C then was 7.5%. Because of the high frequency of hypoglycaemia, she was kept on her glargine but in divided doses. Aspart doses were also reduced. To further improve her HbA1C, her mane cortisone acetate dose was decreased from 18.75 to 17.5mg as well. 

In her 2nd trimester, her HbA1C improved to 6.3%. Nevertheless, she still had nausea and frequent hypoglycaemic episodes. Her insulin doses were further reduced and dietary changes were made. Although she did not have any significant postural hypotension, her mane cortisone acetate was increased due to the persistent nausea and in preparation for her 3rd trimester. 

Her HbA1C was 6.9% at her 3rd trimester. 3 monthly screens for diabetic microvascular complications were negative. There were also no complications with her fetal growth and activity. Mrs CJ declined a C-section and went into spontaneous labour at 39 weeks with a labour management plan for her diabetes and Addisons disease. As she developed tachycardia, a mid-cavity forceps delivery was performed to avoid prolonged labour. The baby was healthy and only required a short stay in the special care nursery. The patient made a good recovery post delivery and was put back on her usual doses of insulin. Nevertheless, despite a dramatic drop in her insulin doses, she continued to have hypoglycemic episodes. 

  1. Stechova et al, 2004. Pregnancy in a woman suffering from type 1 diabetes associated with Addison’s disease and Hashimoto’s thyroiditis (fully developed Autoimmune Polyglandular Syndrome Type 2). Exp Clin Endocrinol Diabetes 2004 Jun; 112(6): 333-7
  2. Lepercq et al, 2012. Meta-Analysis of Maternal and Neonatal Outcomes Associated with the Use of Insulin Glargine versus NPH insulin during Pregnancy. Obstet Gynecol Int. 2012; 2012:649070. Epub 2012 May 16