Why it is important

Diabetes mellitus can either affect women before they become pregnant (types 1 and 2 diabetes (T1DM and T2DM)) or can occur de novo in pregnancy (gestational diabetes mellitus (GDM)). We have research projects focusing on all types of diabetes mellitus in pregnancy.

Women with pre-existing T1DM and T2DM have increased risks of adverse pregnancy outcomes, including birth defects and stillbirth. Those with GDM are at risk of having babies that are large for gestational age, which is associated with an increased risk of obstructed labour. The children of pregnant women with diabetes are more likely to have increased adiposity, dyslipidaemia, and insulin resistance than the children of women without diabetes.

Summary of current research

Sian Chivers is funded by a Diabetes UK Fellowship to study the impact of maternal T1DM and T2DM on the heart of the developing fetus. She is studying the rhythm and functioning of the heart. We are also investigating the impact of GDM on the fetal heart.

Additional projects are evaluating the role of bile acid signalling in GDM. We have shown a positive correlation between serum bile acid concentrations and insulin resistance in GDM. Furthermore, there are distinct serum bile acid profiles in women of European and South Asian ethnicity. 

In a drug trial, we demonstrated that treatment with ursodeoxycholic acid (UDCA) results in better glycaemic control compared to placebo. Ongoing research is exploring the mechanisms by which UDCA improves glycaemia in women with GDM, and we will also evaluate the future health of children born to mothers treated with UDCA compared to those of placebo-treated pregnancies.

How the research benefits patients

Fetal ECG/heart function research goal:

  • Identify predictors for pregnancies at risk of stillbirth.
  • Next step: Develop rapid interventions to prevent stillbirth in women with diabetes.
  • Potential future study on UDCA:

If confirmed to improve glycemia, UDCA could:

  • Serve as an alternative for women who cannot tolerate metformin.
  • Offer a new treatment to help women with gestational diabetes (GDM) avoid insulin injections during pregnancy.

Researchers

  • Sian Chivers
  • Alice Mitchell
  • Caroline Ovadia
  • Josca Mariette Schoonejans
  • Anna Yang