Dear Dr. Nicholson: During my pregnancy, I seem to have appointments with my medical team every week! Who are all these doctors? What are all the tests they have been scheduling? Are they looking for something in particular?
Diabetes is a serious condition and in pregnancy, diabetes affects two patients: the expectant mother and the baby. Taking care of two patients can require extra medial visits. Expectant mothers are at risk of developing labor and birth complications, including high blood pressure and preeclampsia. The baby is at risk for being overly large at birth (sometimes referred to as macrosomia), which can cause birth injuries, glucose intolerance and obesity in childhood. Babies born to mothers with diabetes, especially type 1 or type 2, are also at risk of being too small, often referred to as intrauterine growth restriction.
The goal of your diabetes management team of physicians, diabetes educators, nutritionists, is to help you have a healthy pregnancy and a healthy baby. In order to accomplish this goal, you will need additional prenatal appointments to achieve the following tasks: 1) manage and stabilize your glucose levels, 2) screen for and identify co-morbid maternal conditions, 3) assess fetal well-being, and 4 )diabetes health maintenance.
Appointments for diabetes health maintenance – Being pregnant is no excuse for not being compliant with diabetes health maintenance. There are diabetes-related complications that can occur in pregnant or non-pregnant women. Routine ophthalmology exams to screen for retinal disease is a key component of diabetes care. Specialized foot care with a trained podiatrist is another important visit. As an individual with type 1 or type 2 diabetes, you may be at risk for kidney disease. As a result, your provider may prescribe medications to help preserve the function of your kidneys. Some of these meds are not approved for use in pregnancy, so it will be important
Additional visits to assess fetal well-being and growth - Your doctor will plan for additional testing to ensure the well -being and appropriate growth of your infant. Two primary tests used to assess fetal well-being are the Non-stress tests and the Biophysical profile assessment. A non-stress test is ….. . A biophysical profile is ….. Your provider may also order serial ultrasounds to make sure that your baby is growing appropriately and will be the right size. Your provider will want to make sure that your baby is not growing too big or is not growing big enough. The timing of these tests and the intervals in which they occur will depend on your type of diabetes (type 1, type 2, gestational), whether your pregnancy is complicated by other pregnancy or medical conditions, such as high blood pressure or renal disease. If your baby is small, you may undergo additional testing with uterine dopplers.
More prenatal visits to manage or stabilize blood glucose levels – it can be challenging to keep your blood glucose levels under good control during pregnancy. Your provider and your diabetes management team is there to help you. It is often said that it “takes a village.” Take advantage of “your village” during this incredible important moment in your life. If you have type 2 or type 2 diabetes, you could become frustrated because you blood sugar levels may vary much more than they did before pregnancy. If you are diagnosed with gestational diabetes, the recommended change in your diet can be challenging. Also, the goals for your blood glucose levels during pregnancy can be much lower in pregnancy than when you are not pregnant. Tighter glucose control in pregnancy is thought be help your baby to grow to a healthy size, and for you to have a healthier pregnancy.
Screen for and identify co-morbid maternal conditions – type 1, type 2 or gestational diabetes can be associated with other maternal co-morbid conditions. Hypertension (high blood pressure) occurs in up to 14% (14 out of every 100 women with gestational diabetes). It is very important for your doctor to identify any changes in your blood pressure. Your provider may decide to follow your blood pressures or alternatively, to place you on an anti-hypertensive medication that has been approved for pregnancy. Mothers with type 1 or type 2 diabetes have often been diagnosed with high blood pressure before pregnancy and were placed on medications prior to pregnancy. Women who have been diagnosed with high blood pressure before pregnancy or those who develop high blood pressure during pregnancy, are at risk for preeclampsia. Preeclampsia ,a hypertensive disorder of pregnancy that is characterized by elevated blood pressures, and changes in renal or liver functioning, accounts for 25% of preterm births and accounts for a substantial amount of maternal morbidity.
If you have diabetes or develop diabetes during pregnancy, you are very likely to additional visits beyond the standard prenatal visits. The additional visits are to ensure tight control of your glucose levels, ensure that your other diabetes-related testing is up to date, assess fetal growth and well-being and to screen for other pregnancy-related complications that can occur in women with diabetes. We know that your goal is to have a healthy pregnancy. Communicate with your provider and diabetes educator about any questions you may have about additional prenatal visits. The goal is to have a healthier you, a healthier pregnancy and a healthier newborn.
Dr. Nicholson is an Associate Professor in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. She is a board-certified obstetrician-gynecologist and a perinatal epidemiologist. Through funding from the American Diabetes Association (ADA), Dr. Nicholson has developed a postpartum-specific weight loss intervention, First WIND (Weight-loss Interventions after Delivery), for women at risk for type 2 diabetes which was piloted among urban-based women in Baltimore City. She was previously an investigator with the Johns Hopkins Evidence-Based Practice Center where she was the PI of the task report on Labor and Postpartum Management of Gestational Diabetes, funded through the Agency for Healthcare Research and Quality. Dr. Nicholson is a member of the ACOG National Committee on Health Care for Underserved Women, the US Preventive Services Task Force, and the NC Diabetes Advisory Council.