SAN DIEGO — Comprehensive diabetes education is necessary to ensure that women with diabetes of childbearing age receive proper care that spans preconception to pregnancy and postpartum follow-up, according to a speaker here.
“I really believe that education is the key, that people are just starving for education about diabetes in general, and pregnancy in particular,” Jamie Jadid, MSN, APRN, FNP, BC-ADM, CDE, a nurse practitioner at the High Risk Pregnancy Center, a perinatal practice in Las Vegas, said during a presentation at the American Association of Diabetes Educators annual meeting. “There seems to be a gap between those who provide health care for women specifically, and those who provide health care for persons with diabetes specifically.”
To bridge that gap, Jadid said, health care providers and diabetes educators should talk with women with diabetes of childbearing age about their health risks related to pregnancy, proper preconception planning and screenings, and dispel any myths or fears a patient may have regarding diabetes and pregnancy.
Women with diabetes are at increased risk for several conditions or complications during pregnancy, Jadid said, including miscarriage, pregnancy-induced hypertension, increased cesarean section rate and large babies resulting in birth injury, as well as neonatal complications, including jaundice, hypoglycemia, respiratory distress, congenital abnormalities and preterm birth.
Microvascular and macrovascular complications associated with high blood glucose also increase risk in pregnancy, Jadid said.
“There’s nothing more microvascular than a placenta,” Jadid said. “If you have a woman who has microvascular or macrovascular disease, you have to think that she might have a problem with the placenta.”
The risks can extend to women who develop gestational diabetes during pregnancy, Jadid said. Using current criteria, about 18% of pregnant women will be diagnosed with gestational diabetes, Jadid said; 15% of those women will require oral medications or insulin. After pregnancy, the condition will not resolve in 5% to 10% of women, and many women never receive follow-up postpartum diabetes screenings, Jadid said.
“Women who have had gestational diabetes have anywhere from a 35% to 65% chance of developing type 2 diabetes in the future,” Jadid said. “It’s a red flag, and they need to be aware of that.”
In addition, 86 million Americans have prediabetes, according to the CDC, and a large percentage of those people don’t know they have the condition, Jadid said. Often, those women, who are at high risk for developing type 2 diabetes, are able to manage their risk before pregnancy, but that changes once they become pregnant.
Healthy diet, healthy baby
What the fetus is exposed in utero matters, Jadid said. Studies show that neonates born to women with obesity have a 69% increase in hepatic fat storage, activating epigenetic signals such as inflammatory cytokines that often lead to obesity and metabolic syndrome in childhood.
“If we can educate our patient and get that cycle spinning in the right way, think what a difference it can make,” Jadid said.
Health care providers should counsel women with diabetes to maintain a healthy diet, increase physical activity and monitor their blood glucose four times daily. If a woman is unable to control her blood glucose with diet, insulin may be recommended during pregnancy, Jadid said.
“Occasionally we use metformin ... though it does cross the placenta,” Jadid said and added it can be a good choice for women who were taking metformin before becoming pregnant.
Pregnancy care for a woman with diabetes continues after delivery, Jadid said. Postpartum, health care providers should discuss the importance of healthy eating and breast-feeding (which can promote weight loss) and examine any medication use, restarting and adjusting therapies that were stopped due to pregnancy, when appropriate. At 6 weeks postpartum, every woman with gestational diabetes should undergo a 75 g oral glucose tolerance test to screen for type 2 diabetes, with follow-up occurring every 1 to 3 years.
“If they [primary care physicians] just perform an HbA1c [test], of course it’s going to be normal, because I just controlled their blood sugar with insulin,” Jadid said.
For women with pregestational diabetes, a continuous glucose monitor, if possible, can often serve as a “security blanket” after pregnancy as they may struggle to manage diabetes self-care while caring for a new baby, Jadid said.
“We have an amazing opportunity to not only make your patients healthier, but their children and grandchildren healthier,” Jadid said.
“Moving forward, I would like to see more collaboration between diabetes providers and women’s health providers,” Jadid told Endocrine Today. “Every diabetic woman of childbearing age should be referred for diabetes education so she understands the risks related to pregnancy and the importance of glycemic control and contraception. In consideration of the increasing incidence of obesity and type 2 diabetes in in young women, more research examining effective treatments for that population would be beneficial.” – by Regina Schaffer
Reference: Jadid J. S18. Optimizing Pregnancy Outcomes with Diabetes Education: Before, During and After Pregnancy. Presented at: AADE 2016; Aug. 12-15, 2016; San Diego.
Disclosure: Jadid reports no relevant financial disclosures.