 in order to give birth requires large amounts of energy. That creates greater pressure for adequate blood glucose and insulin levels.
Artificial pancreas technology builds on and improves continuous glucose monitoring systems. University of Cambridge
Glucose levels are typically maintained during the birth through an intravenous glucose infusion and a manually adjustable dose of insulin. The insulin makes sure that the mother’s cells can absorb enough glucose, which in turn prevents the baby’s blood sugar levels from dropping to potentially fatal levels (neonatal hypoglycaemia).
After delivery, the insulin requirement drops sharply and clinical staff must be careful not to give the mother too much and reduce her blood sugar to a dangerous level (maternal hypoglycaemia). This risk develops soon after contractions have ended, especially if the mother quickly begins breastfeeding and if medication given to her for labour prevents her from recognising the symptoms of hypoglycaemia.
With all these complications, it is small wonder that diabetic women are often advised to opt for caesarean sections, although these carry their own post-operative risks as nutrition and mobility are again impaired.
The advent of the artificial pancreas has the potential to change this. The technology uses a sensor embedded beneath the skin to determine blood glucose levels and trends and passes that information to the clinical staff. An external electronic device then uses an algorithm to decide how much insulin is needed and administers it using a pump.
Because the glucose readings come from tissue fluid, they only approximate blood sugar levels and can be inaccurate if the levels are changing quickly. Many of the artificial pancreas algorithms used recently in research could cope with making automatic adjustments to the insulin pump output but would not yet be trusted to do so in all circumstances.
Joan Taylor describes her work on artificial pancreas technology
In critical care, including labour, some manual input for the artificial pancreas will still be important for safety. But eventually the technology will become fully automatic and should greatly reduce the present tragedies in maternity diabetes.
A fully internalised bionic pancreas is much further away – but whether biological, electronic, chemical or even mechanical, this will eventually solve the diabetes problem. Meanwhile the reported case of the first natural birth with the artificial pancreas in Norwich represents a triumph.