Perspectives on Diabetes Care

Diabetes and Pregnancy

Aug 11, 2013, 01:00 AM

If you have been following the AADE blogger coverage of the Annual Meeting, you may have seen that I stayed home this year and was able to log into the Virtual Meeting to get CE credit. I enjoyed viewing the “Controversies in Gestational Diabetes: Diagnosis, Treatment and More,” by Julie Daley. I worked for a few years in my Health Department’s WIC program and after giving birth to my second child this year, I have an interest in the relationship to healthy pregnancies and diabetes. Thankfully, I did not have blood sugars out of range with either pregnancy, but I have had several close friends diagnosed with gestational diabetes or have had at least one value above recommended range from their oral glucose tolerance test (OGTT).

I highly recommend participating in this session if you work with diabetes and pregnancy or gestational diabetes. There are numerous controversies with diabetes and pregnancy that were highlighted. Since this field is so sensitive when it comes to research, medical centers and practices may come up with their own guidelines taking all of the recommendations into consideration.

Some of the thing I learned or was reminded of:

• In pregnancy, there is not really a magic level of the blood sugar where it switches to “bad.” It is a steady relationship. Higher blood sugar equals more adverse outcomes.
• One psychological difference between someone diagnosed with type 2 diabetes and gestational diabetes (GDM) is that with type 2 they can ease into learning and adjusting. With GDM, it is all at once and changes must be made immediately, which can be very emotional for the pregnant woman.
• That 66 percent of women with GDM will develop GDM in subsequent pregnancies. Of those with GDM, 40-60 percent will develop type 2 diabetes (5 percent within 6 months and 60 percent within 10 years).
• Babies are at risk for asphyxia or respiratory distress since lung tissue does not mature as quickly if mom has diabetes, especially if they deliver early.
• Moms who have had bariatric surgery do not tolerate “glucola” or the glucose load of an OGTT. For those patients, they can do fasting blood sugar and 1 hour postprandial (pp) checks at 22-24, 28-32, and 34 weeks; OR they can do fasting blood glucose and 1 hour pp with meter at home OR an intervenous glucose tolerance test with a 60 minute check and use a special formula to find if GDM.
• Having a history of small, gestational age baby is also a risk factor for GDM. I knew large baby was, but had not heard of small babies as well.
• Having polycystic ovarian syndrome is a risk factor for GDM. PCOS affects 5-10 percent of women of reproductive age and of those, 26-46 percent will develop GDM. PCOS patients have a higher rate of gestational hypertension and more preterm deliveries.
• If a patient is on metformin, studies are conflicted as to when metformin should be discontinued after conception.
• Before the OGTT, advise patients to just eat normally. If you don’t eat any carbohydrate, it actually can make blood glucose higher.
• Her practice has women repeat their OGTT if one out of three values is elevated since women with one elevated value still have increased risk for macrosomia and other morbidities.
• If at the first prenatal visit, blood sugar is elevated, she calls it type 2 diabetes - not GDM.
• Women with GDM need individualized nutrition plans from a dietitian, not a tear sheet. At her practice, she usually does 40-45 percent carbohydrate of the patient’s total calories. Then, three moderate meals, with 2-4 snacks, and the bedtime snack at 30g carbohydrate.
• Research has not proven that 1 hour postprandial testing is better than 2 hour postprandial tests for at home testing of blood glucose with GDM.
• For frequency of at home testing with GDM, her office guidelines state that if the patient’s values are within normal limits they may move to every other day or two days a week testing and they are currently conducting a study on this.
• She likes to use 60 mg/dl for hypoglycemia since pregnant women run lower blood sugar, but some practices use the standard of 70 mg/dl.

There’s still time to sign up to attend the virtual meeting, so if you missed this one login today!