Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Background: Women with diseases of the exocrine pancreas are predisposed to insulin deficiency, presenting as diabetes of the exocrine pancreas (DEP).^1-3 Pregnancy can complicate management of pre-existing DEP or unmask diabetes (DM), which may be misinterpreted as uncomplicated gestational diabetes (GDM). We describe a large series of pregnant women with DEP or GDM on a background of disease of the exocrine pancreas.

Methods: An antenatal database search identified 11 consecutive patients managed through the tertiary centre at John Hunter Hospital, Newcastle from 2012-2021.

Outcomes: Mean age was 26.5 years and 8 were primipara (Table). All 11 women were insulin-treated during pregnancy, five were on insulin pre-conception including one via insulin pump. Two women with pre-existing DEP, not requiring insulin preconception, commenced insulin at week 8 of pregnancy. Four women were screened and diagnosed with GDM at weeks 12, 19, 28 and 28, and commenced insulin at week 24, 19, 30 and 31 of gestation respectively. One of these four women had a negative early screen at week 12, but required insulin following steroid use for exacerbation of cystic fibrosis. Pregnancy was complicated by pre-eclampsia in two women, and one developed ketosis requiring intravenous insulin. There was a significant rate of maternal hypoglycaemia (6/11), acute presentations requiring hospital admission (6/11) and early delivery (average 36.8 weeks). Post-partum, three neonates developed hypoglycaemia and one was diagnosed with respiratory distress syndrome.

Discussion: In the general population, DEP is more common than Type 1 DM, and confers a higher risk of sub-optimal glycaemic control compared to Type 2 DM despite a need for early insulin initiation.⁴ DEP may be under-represented in our database due to misclassification.^2,4 Evidence to guide antenatal management is lacking, but women are at potential risk of complications. Early diabetes screening is recommended in women with diseases of the exocrine pancreas.

References:

^{1. Wynne K, Devereaux B and Dornhorst A. Diabetes of the exocrine pancreas. Journal of Gastroenterology and Hepatology (2019) 34:2, 346-354}

^{2. Petrov MS and Basina M. Diagnosing and classifying diabetes in diseases of the exocrine pancreas. European Journal of Endocrinology (2021) 184 R151-R163}

^{3. Petrov MS. Post-pancreatitis diabetes mellitus: prime time for secondary disease. European Journal of Endocrinology (2021) 184, R137-R149}

^{4. Woodmansey C et al. Incidence, demographics, and clinical characteristics of diabetes of the exocrine pancreas (type 3c): a retrospective cohort study. Diabetes Care (2017) 40, 1486-1493}