October 10, 2003

Caring for pregnant women with diabetes can be challenging

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Dr. Steven G. Gabbe. Dean Dixon

Caring for pregnant women with diabetes can be challenging

Caring for obstetrical patients with diabetes can be a challenging balancing act, but one that will ultimately pay off with a healthy mother and a healthy infant, according to an article written by Drs. Steven G. Gabbe and Cornelia R. Graves of Vanderbilt University Medical Center in the October issue issue of Obstetrics and Gynecology, the official journal of the American College of Obstetricians and Gynecologists.

The article appears in the High Risk Obstetrics series: an expert’s view.

Diabetes, a relatively common complication of pregnancy, complicates 3 percent to 5 percent of all pregnancies.

The most common form of diabetes that complicates pregnancy is gestational diabetes, which is called by some “ a sneak peak into the future,” since at least half of the women who develop gestational diabetes will develop type 2 diabetes later in life, Gabbe said.

“It gives us an opportunity to identify women at risk for type 2 diabetes later on, and perhaps by initiating interventions after their pregnancy — counseling them about weight loss, exercise and a healthy diet — we can prevent or delay the onset of type 2 diabetes.”

Women with type 1 diabetes have many treatment options, such as new insulins, monitoring devices for glucose and insulin pumps, so the ability to achieve excellent glucose control is much easier today than in previous years, Gabbe said.

“For the woman who is pregnant and has type 1 diabetes, excellent control is going to benefit her baby, and we’re going to see that outcome in nine months,” Gabbe said. “We know that excellent glucose control is important to prevent complications in the mother also, and those complications occur 10, 20 or 30 years after diabetes has first been diagnosed.

Education is also an important part of what the obstetrician can do to help the mother not only during pregnancy, but in the future as well.

“We also hope what we teach the patients in pregnancy, when they’re highly motivated to learn and they want to do everything they can to help their baby, will be lessons they can apply throughout their lives, such as how to manage their diet and insulin, and how to check their blood glucose. We hope these are lessons for life.”

The article also pointed out that the care of the pregnant patient with diabetes should begin before she becomes pregnant so she can enter the pregnancy in excellent control, therefore reducing the risk even further of having a baby with major malformations, or having a miscarriage.

“We believe, by and large, obstetricians are aware of these guidelines, and we hope that our update of the best practices will serve as a careful reference as they care for women whose pregnancies are complicated by diabetes,” Gabbe said.