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Managing Diabetes in Pregnancy
Dr. Spencer Kuper discusses gestational diabetes, how patients are screened for gestational diabetes, pregnancy complications from gestational diabetes, prevention tips and if there are treatment options available.
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Learn more about Spencer Kuper, MD
Spencer Kuper, MD
Spencer Kuper, MD is the Maternal Fetal Medicine Specialist at Tri-State Perinatology.Learn more about Spencer Kuper, MD
Transcription:
Melanie Cole (Host): Welcome. Today we are talking about gestational diabetes, as it is on the rise with pregnant women and there are many treatment options for women that have been diagnosed with gestational diabetes. My guest is Dr. Spencer Kuper. He’s a Maternal Fetal Medicine Specialist at Tri-State Perinatology at the Women’s Hospital. Dr. Kuper, thank you so much for joining us today. what is gestational diabetes?
Spencer Kuper, MD (Guest): It’s my pleasure. Thank you for having me. Gestational diabetes is a condition that’s exclusive to pregnancy. But it does affect women that are more prone to get type 2 diabetes later in life. So, it’s a condition where there are certain chemicals that the placenta makes or certain hormones that makes your body more resistant to insulin. So, it increases your risk of complications both for mom and baby during the pregnancy.
Host: Who is at risk? Is there a genetic component? If your mother had gestational diabetes, does that mean that if you get pregnant, you’re probably more at risk? Or if you’ve had previous diabetes would that put you at risk for this as well?
Dr. Kuper: That’s exactly right. Every single pregnant patient is at risk but those at the greatest risk are those with mothers or fathers who have diabetes, aunts and uncles or grandparents with diabetes. There is absolutely a genetic component to that and most of the patients that we see with gestational diabetes, you ask them, and they say that their mom or their dad has type 2 diabetes. So, when there’s that family history, it’s more of a type 2 rather than type 1 family history. But it is intricately related.
Host: Well thank you for that answer. So, if somebody is diagnosed and we’ll talk about diagnosis in a minute; do you then consider this a high risk pregnancy?
Dr. Kuper: We absolutely do. It definitely increases the risk of complications but with careful following by your doctor, and by attending all appointments, you can absolutely take the risk back down to close to normal.
Host: So, then how would a woman know? Are we checking for this all throughout the pregnancy? Are there symptoms that she might recognize and if so, then how do you diagnose it?
Dr. Kuper: There are. So, every single patient between 24 and 28 weeks of gestation is screened for gestational diabetes. It’s standard of care in the United States that every single pregnant patient is screened for this. And how they are screened for this is an orange drink called a glucola and you drink it and you don’t have to be fasting or without food for that. You just come in for your scheduled appointment, drink the orange drink and then have your blood checked an hour later. And so we screen for it that way and if it’s above a certain level, 135 is what we use in our office. If it’s above that level, then we talk about working up further to see if you definitely have the condition.
With this being a screening test, we want to definitely make sure we are correct in the diagnosis so if you don’t pass that first test, again with that one hour level being greater than 135; then we ask you to come back another day when you are fasting or first thing in the morning when you have had nothing to eat and we use a higher dose of the glucose. It’s called a glucose tolerance test. And then we check your levels before the test, and then for three hours. So, at one hour, two hours and three hours and that’s how we classify whether you do or do not have gestational diabetes.
So, a lot of women will actually not pass that first hour, that first test but will go on and pass that three hour glucose tolerance test. So, only the women that fail that second test actually have gestational diabetes.
Host: Okay. So, if they fail that second test; why is it then so important to control their blood sugar? What complications can arise whether it’s for mom or baby if a woman has uncontrolled gestational diabetes?
Dr. Kuper: I like to break it into mom and baby first and talking about the mother complications. Preeclampsia is a condition of spasm of the arteries and it can cause complications during pregnancy and lead towards preterm birth and even some serious maternal or mom conditions. With adequate treatment of gestational diabetes, we can absolutely decrease the risk of mother developing preeclampsia.
Other conditions, more so for baby is baby can get too large and babies of moms who have diabetes, they actually put their fat in their shoulders so those babies when they are born, if they are too large; are at risk of getting stuck when they are born and that’s something called a shoulder dystocia which is an emergency in our field and can lead towards nerve damage for baby and also can lead towards worsening tears such as a third or fourth degree laceration for mom. And then the last thing is with mothers who have high blood sugars, babies can actually have low blood sugars when they are born. So, that can be a complication with the babies.
But with adequate treatment during pregnancy, we can absolutely decrease these risks.
Host: So, what does that look like then Dr. Kuper. What does adequate treatment mean and how does a maternal fetal medicine specialist such as yourself manage diabetes in pregnancy?
Dr. Kuper: So, we work exceedingly closely with our dieticians and our dieticians are one of the most important players in our field. And when a patient is diagnosed with gestational diabetes and their doctor calls us and asks us to see the patient; the very first thing that we want to do is meet with the patient and to have them meet with the dietician here at the Women’s Hospital. Our dieticians are absolutely integral at explaining to the patient an adequate diet for gestational diabetes to limit their carbohydrate and their sugar intake. And with a lot of patients, by just altering their diet and that education with our dietician; we can control their blood sugars, so they are within normal range and a lot of patients don’t even need medications to help with their diabetes.
So, that first visit is meeting with our dietician and then for the next week, we check their blood sugars and so they check their blood sugar at home and record those blood sugars and then bring them in the next week. During that next week, they meet with the physician and also a nurse practitioner and we go through every single blood sugar that they have taken, four times a day. So, when they wake up before they eat anything, and then two hours after each meal and we scrutinize and go through that log and look at what they ate with each meal to see if we could improve their diet in any way. And during that time, also, that next week, the one week later; we typically do an ultrasound too to evaluate baby’s overall estimated fetal weight and to check the wellbeing of their child.
Host: So, it’s a real comprehensive multidisciplinary team that’s involved, yes?
Dr. Kuper: It is. We use – they will see at least four different people during their appointment. It’s typically a three to four hour appointment because we take it so seriously and because we can improve mom and baby outcomes.
Host: So, then along those lines, if the patients get their blood glucose levels under control, they listen to you their doctor and the dietician and everyone involved; can they still expect to deliver a healthy baby? Because moms are nervous. This is their biggest fear, right?
Dr. Kuper: That’s exactly right. And this is the most important time in a mom and dad’s life, and we can absolutely help them deliver a healthy baby. Excellent outcomes for moms who have gestational diabetes with controlling their blood sugars.
Host: So, when we are talking about controlling their blood sugars and obviously nutrition, dietetics those are one way; what about thing like exercise? Can a woman with gestational diabetes exercise Doctor? Can they involve themselves in a supervised exercise program and will that help as well?
Dr. Kuper: We strongly encourage exercise in pregnancy for all of our patients. But those patients with diabetes; they are absolutely – pregnancy helps decrease their blood sugar levels. So, what we will tell a lot of our mothers that have done everything with their diet and really tried and we are at that point of considering medication; we talk to them about exercising; after their meals going for a 20 or 30 minute walk with their family and at that point, we’ve seen significant improvement in their blood sugars and actually being able to avoid medications by simply increasing activity and exercising.
Host: Isn’t that amazing? What a great bit of advice. So, please wrap it up for us with your best advice about lifestyle and management, prevention, what would you like people to know about gestational diabetes and controlling their blood sugar and controlling their risk for future pregnancies that might involve gestational diabetes?
Dr. Kuper: You know pregnancy is a glimpse into the future health for everyone. So, it’s a great opportunity. When else during your life do you get to see a doctor every two to four weeks and have someone looking in on your urine, your blood pressure, your baby. And with gestational diabetes, it’s a glimpse into the future. We can improve your outcome for sure with your baby, with healthy diet, exercise, potentially medication, but what is great about it is you know with gestational diabetes; there’s that risk of developing type 2 diabetes later in life and that risk is upwards of 50 to 70%. But with continuing those good habits that you developed during pregnancy with good diet, your exercise and then attempting weightloss after pregnancy; we can significantly drive down that risk of developing type 2 diabetes later in life.
So, I tell my patients that the diagnosis of gestational diabetes is not something to be upset about but it’s really to give you hope for the future to decrease that risk of developing type 2 diabetes and all the complications that come from type 2 diabetes late in life.
Host: It’s great information, Doctor. Thank you so much for joining us and giving hope to women who may have been diagnosed with diabetes in pregnancy. Thank you again for all of that great advice.
That wraps up this episode of The Women’s Hospital – A Place for All Your Life. To schedule an appointment or to learn more about high risk pregnancy and Tri-State Perinatology at The Women’s Hospital, head on over to our website at www.deaconess.com/tsp to get connected with one of our providers. If you found this podcast informative and I certainly did, it was such great information and if you know any pregnant women; it’s really a great idea to share this with them because you are learning from the experts at Deaconess The Women’s Hospital. So, you can also check out all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): Welcome. Today we are talking about gestational diabetes, as it is on the rise with pregnant women and there are many treatment options for women that have been diagnosed with gestational diabetes. My guest is Dr. Spencer Kuper. He’s a Maternal Fetal Medicine Specialist at Tri-State Perinatology at the Women’s Hospital. Dr. Kuper, thank you so much for joining us today. what is gestational diabetes?
Spencer Kuper, MD (Guest): It’s my pleasure. Thank you for having me. Gestational diabetes is a condition that’s exclusive to pregnancy. But it does affect women that are more prone to get type 2 diabetes later in life. So, it’s a condition where there are certain chemicals that the placenta makes or certain hormones that makes your body more resistant to insulin. So, it increases your risk of complications both for mom and baby during the pregnancy.
Host: Who is at risk? Is there a genetic component? If your mother had gestational diabetes, does that mean that if you get pregnant, you’re probably more at risk? Or if you’ve had previous diabetes would that put you at risk for this as well?
Dr. Kuper: That’s exactly right. Every single pregnant patient is at risk but those at the greatest risk are those with mothers or fathers who have diabetes, aunts and uncles or grandparents with diabetes. There is absolutely a genetic component to that and most of the patients that we see with gestational diabetes, you ask them, and they say that their mom or their dad has type 2 diabetes. So, when there’s that family history, it’s more of a type 2 rather than type 1 family history. But it is intricately related.
Host: Well thank you for that answer. So, if somebody is diagnosed and we’ll talk about diagnosis in a minute; do you then consider this a high risk pregnancy?
Dr. Kuper: We absolutely do. It definitely increases the risk of complications but with careful following by your doctor, and by attending all appointments, you can absolutely take the risk back down to close to normal.
Host: So, then how would a woman know? Are we checking for this all throughout the pregnancy? Are there symptoms that she might recognize and if so, then how do you diagnose it?
Dr. Kuper: There are. So, every single patient between 24 and 28 weeks of gestation is screened for gestational diabetes. It’s standard of care in the United States that every single pregnant patient is screened for this. And how they are screened for this is an orange drink called a glucola and you drink it and you don’t have to be fasting or without food for that. You just come in for your scheduled appointment, drink the orange drink and then have your blood checked an hour later. And so we screen for it that way and if it’s above a certain level, 135 is what we use in our office. If it’s above that level, then we talk about working up further to see if you definitely have the condition.
With this being a screening test, we want to definitely make sure we are correct in the diagnosis so if you don’t pass that first test, again with that one hour level being greater than 135; then we ask you to come back another day when you are fasting or first thing in the morning when you have had nothing to eat and we use a higher dose of the glucose. It’s called a glucose tolerance test. And then we check your levels before the test, and then for three hours. So, at one hour, two hours and three hours and that’s how we classify whether you do or do not have gestational diabetes.
So, a lot of women will actually not pass that first hour, that first test but will go on and pass that three hour glucose tolerance test. So, only the women that fail that second test actually have gestational diabetes.
Host: Okay. So, if they fail that second test; why is it then so important to control their blood sugar? What complications can arise whether it’s for mom or baby if a woman has uncontrolled gestational diabetes?
Dr. Kuper: I like to break it into mom and baby first and talking about the mother complications. Preeclampsia is a condition of spasm of the arteries and it can cause complications during pregnancy and lead towards preterm birth and even some serious maternal or mom conditions. With adequate treatment of gestational diabetes, we can absolutely decrease the risk of mother developing preeclampsia.
Other conditions, more so for baby is baby can get too large and babies of moms who have diabetes, they actually put their fat in their shoulders so those babies when they are born, if they are too large; are at risk of getting stuck when they are born and that’s something called a shoulder dystocia which is an emergency in our field and can lead towards nerve damage for baby and also can lead towards worsening tears such as a third or fourth degree laceration for mom. And then the last thing is with mothers who have high blood sugars, babies can actually have low blood sugars when they are born. So, that can be a complication with the babies.
But with adequate treatment during pregnancy, we can absolutely decrease these risks.
Host: So, what does that look like then Dr. Kuper. What does adequate treatment mean and how does a maternal fetal medicine specialist such as yourself manage diabetes in pregnancy?
Dr. Kuper: So, we work exceedingly closely with our dieticians and our dieticians are one of the most important players in our field. And when a patient is diagnosed with gestational diabetes and their doctor calls us and asks us to see the patient; the very first thing that we want to do is meet with the patient and to have them meet with the dietician here at the Women’s Hospital. Our dieticians are absolutely integral at explaining to the patient an adequate diet for gestational diabetes to limit their carbohydrate and their sugar intake. And with a lot of patients, by just altering their diet and that education with our dietician; we can control their blood sugars, so they are within normal range and a lot of patients don’t even need medications to help with their diabetes.
So, that first visit is meeting with our dietician and then for the next week, we check their blood sugars and so they check their blood sugar at home and record those blood sugars and then bring them in the next week. During that next week, they meet with the physician and also a nurse practitioner and we go through every single blood sugar that they have taken, four times a day. So, when they wake up before they eat anything, and then two hours after each meal and we scrutinize and go through that log and look at what they ate with each meal to see if we could improve their diet in any way. And during that time, also, that next week, the one week later; we typically do an ultrasound too to evaluate baby’s overall estimated fetal weight and to check the wellbeing of their child.
Host: So, it’s a real comprehensive multidisciplinary team that’s involved, yes?
Dr. Kuper: It is. We use – they will see at least four different people during their appointment. It’s typically a three to four hour appointment because we take it so seriously and because we can improve mom and baby outcomes.
Host: So, then along those lines, if the patients get their blood glucose levels under control, they listen to you their doctor and the dietician and everyone involved; can they still expect to deliver a healthy baby? Because moms are nervous. This is their biggest fear, right?
Dr. Kuper: That’s exactly right. And this is the most important time in a mom and dad’s life, and we can absolutely help them deliver a healthy baby. Excellent outcomes for moms who have gestational diabetes with controlling their blood sugars.
Host: So, when we are talking about controlling their blood sugars and obviously nutrition, dietetics those are one way; what about thing like exercise? Can a woman with gestational diabetes exercise Doctor? Can they involve themselves in a supervised exercise program and will that help as well?
Dr. Kuper: We strongly encourage exercise in pregnancy for all of our patients. But those patients with diabetes; they are absolutely – pregnancy helps decrease their blood sugar levels. So, what we will tell a lot of our mothers that have done everything with their diet and really tried and we are at that point of considering medication; we talk to them about exercising; after their meals going for a 20 or 30 minute walk with their family and at that point, we’ve seen significant improvement in their blood sugars and actually being able to avoid medications by simply increasing activity and exercising.
Host: Isn’t that amazing? What a great bit of advice. So, please wrap it up for us with your best advice about lifestyle and management, prevention, what would you like people to know about gestational diabetes and controlling their blood sugar and controlling their risk for future pregnancies that might involve gestational diabetes?
Dr. Kuper: You know pregnancy is a glimpse into the future health for everyone. So, it’s a great opportunity. When else during your life do you get to see a doctor every two to four weeks and have someone looking in on your urine, your blood pressure, your baby. And with gestational diabetes, it’s a glimpse into the future. We can improve your outcome for sure with your baby, with healthy diet, exercise, potentially medication, but what is great about it is you know with gestational diabetes; there’s that risk of developing type 2 diabetes later in life and that risk is upwards of 50 to 70%. But with continuing those good habits that you developed during pregnancy with good diet, your exercise and then attempting weightloss after pregnancy; we can significantly drive down that risk of developing type 2 diabetes later in life.
So, I tell my patients that the diagnosis of gestational diabetes is not something to be upset about but it’s really to give you hope for the future to decrease that risk of developing type 2 diabetes and all the complications that come from type 2 diabetes late in life.
Host: It’s great information, Doctor. Thank you so much for joining us and giving hope to women who may have been diagnosed with diabetes in pregnancy. Thank you again for all of that great advice.
That wraps up this episode of The Women’s Hospital – A Place for All Your Life. To schedule an appointment or to learn more about high risk pregnancy and Tri-State Perinatology at The Women’s Hospital, head on over to our website at www.deaconess.com/tsp to get connected with one of our providers. If you found this podcast informative and I certainly did, it was such great information and if you know any pregnant women; it’s really a great idea to share this with them because you are learning from the experts at Deaconess The Women’s Hospital. So, you can also check out all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.