Selected Podcast
Diabetes and Pregnancy
Erin Wright, WHNP-BC explains the different services offered at maternal-fetal medicine, and who might need this specialized care.
Featuring:
Erin Wright, WHNP-BC
Erin Wright, WHNP-BC is a board-certified women’s health nurse practitioner with more than 15 years of experience. She is highly skilled in treating patients with a variety of medical needs, including high-risk and routine obstetric care, and specializes in high-risk pregnancies and maternal-fetal medicine. She welcomes patients at NHRMC Physician Group – Atlantic Fetal Medicine. Transcription:
Prakash Chandran (Host): Pregnancy can bring excitement and also nervousness for many expectant women and couples. If your pregnancy needs more specialized care, your doctor may refer you to a maternal fetal medicine specialist. One of the many reasons you may be referred to this kind of specialist is if you have preexisting or gestational diabetes. Today we have Erin Wright, a woman’s health nurse practitioner with NHRMC Physician Group’s Atlantic Fetal Medicine here to discuss what you need to know about diabetes and pregnancy. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. So first of all Erin, what exactly is the specialty of maternal fetal medicine and some of the reasons a woman may be referred to a maternal fetal medicine.
Erin Wright, WHNP-BC(Guest): Yes. So we see women both in pregnancy and occasionally outside of pregnancy for preconception visits. Typically anyone who’s got an underlying medical condition such as hypertension, an autoimmune disease, something like diabetes, anyone with poor pregnancy history such as recurrent miscarriage or maybe they’ve had preterm delivery in the past, and multiple gestation pregnancies like twins or triplets.
Host: Alrighty. So just speaking more generally, you mentioned diabetes. I’d love for you to talk a little bit more about diabetes and it’s potential consequences on a person’s wellbeing.
Erin: We know that diabetes is certainly one of the leading causes of illness and death worldwide. Certainly in our country about 34 million people are thought to be effected from diabetes. A lot of those people don’t know they have diabetes yet. So we see women who have both preexisting diabetes during pregnancy, and then we also take care of women who get diagnosed with what's called gestational diabetes during pregnancy meaning the pregnancy has brought about some changes in the body that make you unable to process your own insulin as well as we would like you to be able to.
Host: I see. So you mentioned a couple things there and I want to try to break it down. So can you talk through the differences between type 1, type 2, gestational diabetes, and maybe some of the risk factors and some of the symptoms that one might experience.
Erin: Sure. Type 1 is actually sort accounts for the smallest portion of people who have diabetes. That’s caused by the pancreas basically failing, usually very early on in life, to produce enough insulin. That type of diabetes requires lifelong insulin replacement. Type 2 diabetes tends to develop more because a person develops insulin resistance. So their pancreas is still working well enough and putting out insulin appropriately, but their body isn’t using it as well as it could. Then gestational diabetes or pregnancy related diabetes is similar to that. Pregnancy in general causes a little bit of insulin resistance. Women who develop gestational diabetes just don’t have enough to sort of get them over the hump to really counteract that insulin resistance. So they generally need some help with either stricter diet changes or medication.
Host: I see. Okay. Well, that’s very helpful that breakdown. Can you talk a little bit about the risk factors and symptoms that one might experience when they have one of these types of diabetes?
Erin: Primarily for type 2 diabetes and gestational diabetes the risks include obesity, a sedentary lifestyle, other chronic conditions such as high cholesterol or elevated blood pressure. A family history of diabetes increases your risk for developing diabetes if you’ve got a first degree relative like your mother or a sister. Then we know that certain populations just by their ethnicity have an increased risk as well including African Americans, the Latin-X population, Asian, or Indigenous Americans.
Host: I'm curious as to how often you actually see diabetic patients in your practice.
Erin: Oh I would say we probably at least have—On any given day we see probably multiple patients. There are three of us in our practice, and I would say we each have—depending on the day—two to five patients a day with either preexisting diabetes or gestational diabetes. It is quite prevalent.
Host: Yeah. What’s interesting is I remember when my wife was pregnant last year, we had never heard of gestational diabetes before. A couple of her friends were like, “You know I never had any issues before but suddenly I had gestational diabetes.” So I'm curious if you could talk a little bit about gestational diabetes specifically and how common it is and why it seems to appear out of nowhere.
Erin: Yes. That’s an excellent point. I think it is often very disheartening and shocking if a woman gets a diagnosis of gestational diabetes in pregnancy, particularly if they don’t have any risk factors. Many women aren’t aware that this is a possibility. ACOG—which is the American College of Obstetrics and Gynecology—recommends universal screening meaning every woman who is pregnant should have some type of screening for diabetes. Based on what that individual’s risk factors look like, the standard screen happens maybe around the sixth month of pregnancy right around 24 to 26 weeks of pregnancy. That involves taking some type of glucose tolerance test where a woman will drink an additionally sugary drink and have their blood sugar tested an hour or two hours after they drink that drink to see how their body handles that sugar load.
Host: That’s very helpful advice. I want to dig into a little bit more about being diabetic during pregnancy. How do certain types of diabetes complicate pregnancy? Then furthermore what treatments may be available for pregnant women who are diabetic?
Erin: So having preexisting diabetes—meaning if you have type 1 or type 2 diabetes when you actually conceive and get pregnant—that increases your risk for having a birth defect by about 10%. So it is a significant risk factor. Then in general whether it’s preexisting diabetes or gestational diabetes, the complications in pregnancy are fairly significant. It includes increased risk for pre-eclampsia which is a blood pressure problem that really can only be treated by delivery of the baby. There are increased risks for growth problems with the baby. A woman with poorly controlled diabetes can grow too big of a baby and conversely sometimes they can grow too small of a baby because the placenta isn’t working as well as we would like it to. There are problems with increased amniotic fluid levels, the fluid that’s around the baby. Increased risks for placental failure and stillbirth. Then in general the bigger the baby is, the higher the risks are for a woman to need an operative delivery such as c-section or potentially a difficult vaginal delivery which can cause trauma to the mother or the baby. So it is really of the utmost important to have a woman who has diabetes be really well controlled during their pregnancy to try to minimize the risks of those complications.
Host: Okay. So let’s talk about that control and some of the treatments that are available to them to minimize anything going wrong in the pregnancy.
Erin: Insulin is considered the mainstay or the gold standard of treatment in pregnancy. So for women who come to us with preexisting diabetes, if they're already on insulin that’s generally a good thing. Insulin needs will sometimes go up or down depending on the trimester of the pregnancy. Typically it requires a woman to check their blood sugar multiple times a day. We usually have our patients checking four times a day, monitoring their blood sugars, keeping a log of what they're eating, what their blood sugar readings are. Some women who are preexisting diabetic or just gestational diabetic are able to keep their blood sugars within goal with just strict diet changes. Medical nutrition therapy is sort of the fancy word for nutrition counselling. So intense nutrition counselling and helping the woman choose the right combination of carbohydrate and protein and fat can sometimes help without any medication. If a woman is not on medication and they require medication during pregnancy, again insulin is generally the first choice. Although, we are able to use an oral medication called Metformin which is quite commonly used outside of pregnancy in people who have type 2 diabetes. It works well in terms of helping a person use their own insulin a little better and kind of overcome some of that insulin resistance.
Host: Got it. So it does seem like there is a comprehensive set of measures that are available to help reduce the risk of complication if you are diabetic. Is that correct?
Erin: Correct. Along with the management from a medication side or a dietary side, we increased the surveillance of mom and baby during pregnancy to be on the lookout for some of those complications. They will frequently get additional ultrasounds to check on the growth of the baby. They will have a special detailed ultrasound to look for any sign of birth defect or fetal stress defect that can be caused from elevated blood sugars. Women who come to us with preexisting diabetes will generally get what’s called a fetal echocardiogram looking particularly at the baby’s heart since we know diabetes increases the risk for heart structure anomalies. Then towards the end of pregnancy, we generally do some type of weekly or often twice weekly surveillance checking in on that baby and placental function and making sure the baby is well oxygenated and doing well.
Host: Just as we start to wrap up here, I'm curious as to some of the questions that you mainly get from the patients that come in that you’d like to share and address to our listeners.
Erin: Sure. I think probably one of the most common questions—particularly for a woman who gets a diagnosis of gestational diabetes—is will I have to do this after my baby is born? Will I have diabetes after my baby is born? The short answer to that is no. Most of the time after delivery, blood sugar values return to normal and a woman’s ability to use their insulin changes for the better. It does confer an increased risk for developing diabetes later in life both for their child and for themselves. The second question we often get is will this effect my baby? It can potentially cause issues for the baby after delivery. Often times a newborn who’s been exposed to high levels of blood sugar in the last several weeks of pregnancy will have problems regulating it’s own blood sugar. Sometimes those babies need a little bit of help, and they need some extra sugar in those first couple of days after they're delivered. Then, again, the increased risks for the child themselves to develop diabetes later on life. All those complications can be mitigated by trying to maintain that healthier lifestyle and really trying to get out and get some physical activity, watch the amount of sugar and simple sugars in a person’s diet. All of that will go a long way to prevention, which I think is key.
Host: Just a final question here. You’ve seen so many different types of patients. I always like to ask the question what is the one thing that you wish your patients knew before they came to see you?
Erin: So I think in general it’s nice to know that we’re available for preconception consults to help someone get their pregnancy planned ahead of time before they decide to try to become pregnant. For diabetes in particular, I think that can be hugely important. Making sure a woman is on the right amount and kind of medication. There are medications that are used in diabetes outside of pregnancy that are not safe in pregnancy or not well studied in pregnancy. So really getting someone ramped up for a healthy pregnancy in terms of let’s work on your diet, let’s work on your medication regiment, let’s make sure you're getting some healthy physical activity so that you can be at your best for this important part in your life.
Host: Well Erin, I think that’s a perfect place to end. Such great advice. There's no need to wait. You can definitely be proactive and come in sooner. So thank you so much for your time. That’s Erin Wright, women’s health nurse practitioner with NHRMC Physician Groups Atlantic Fetal Medicine at New Hannover Regional Medical Center. Thanks for checking out this episode of healthy conversations. To learn more about the specialists and services offered at Atlantic Fetal Medicine, visit nhrmcphsyiciangroup.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from New Hannover Regional Medical Center. Thanks and we’ll see you next time.
Prakash Chandran (Host): Pregnancy can bring excitement and also nervousness for many expectant women and couples. If your pregnancy needs more specialized care, your doctor may refer you to a maternal fetal medicine specialist. One of the many reasons you may be referred to this kind of specialist is if you have preexisting or gestational diabetes. Today we have Erin Wright, a woman’s health nurse practitioner with NHRMC Physician Group’s Atlantic Fetal Medicine here to discuss what you need to know about diabetes and pregnancy. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. So first of all Erin, what exactly is the specialty of maternal fetal medicine and some of the reasons a woman may be referred to a maternal fetal medicine.
Erin Wright, WHNP-BC(Guest): Yes. So we see women both in pregnancy and occasionally outside of pregnancy for preconception visits. Typically anyone who’s got an underlying medical condition such as hypertension, an autoimmune disease, something like diabetes, anyone with poor pregnancy history such as recurrent miscarriage or maybe they’ve had preterm delivery in the past, and multiple gestation pregnancies like twins or triplets.
Host: Alrighty. So just speaking more generally, you mentioned diabetes. I’d love for you to talk a little bit more about diabetes and it’s potential consequences on a person’s wellbeing.
Erin: We know that diabetes is certainly one of the leading causes of illness and death worldwide. Certainly in our country about 34 million people are thought to be effected from diabetes. A lot of those people don’t know they have diabetes yet. So we see women who have both preexisting diabetes during pregnancy, and then we also take care of women who get diagnosed with what's called gestational diabetes during pregnancy meaning the pregnancy has brought about some changes in the body that make you unable to process your own insulin as well as we would like you to be able to.
Host: I see. So you mentioned a couple things there and I want to try to break it down. So can you talk through the differences between type 1, type 2, gestational diabetes, and maybe some of the risk factors and some of the symptoms that one might experience.
Erin: Sure. Type 1 is actually sort accounts for the smallest portion of people who have diabetes. That’s caused by the pancreas basically failing, usually very early on in life, to produce enough insulin. That type of diabetes requires lifelong insulin replacement. Type 2 diabetes tends to develop more because a person develops insulin resistance. So their pancreas is still working well enough and putting out insulin appropriately, but their body isn’t using it as well as it could. Then gestational diabetes or pregnancy related diabetes is similar to that. Pregnancy in general causes a little bit of insulin resistance. Women who develop gestational diabetes just don’t have enough to sort of get them over the hump to really counteract that insulin resistance. So they generally need some help with either stricter diet changes or medication.
Host: I see. Okay. Well, that’s very helpful that breakdown. Can you talk a little bit about the risk factors and symptoms that one might experience when they have one of these types of diabetes?
Erin: Primarily for type 2 diabetes and gestational diabetes the risks include obesity, a sedentary lifestyle, other chronic conditions such as high cholesterol or elevated blood pressure. A family history of diabetes increases your risk for developing diabetes if you’ve got a first degree relative like your mother or a sister. Then we know that certain populations just by their ethnicity have an increased risk as well including African Americans, the Latin-X population, Asian, or Indigenous Americans.
Host: I'm curious as to how often you actually see diabetic patients in your practice.
Erin: Oh I would say we probably at least have—On any given day we see probably multiple patients. There are three of us in our practice, and I would say we each have—depending on the day—two to five patients a day with either preexisting diabetes or gestational diabetes. It is quite prevalent.
Host: Yeah. What’s interesting is I remember when my wife was pregnant last year, we had never heard of gestational diabetes before. A couple of her friends were like, “You know I never had any issues before but suddenly I had gestational diabetes.” So I'm curious if you could talk a little bit about gestational diabetes specifically and how common it is and why it seems to appear out of nowhere.
Erin: Yes. That’s an excellent point. I think it is often very disheartening and shocking if a woman gets a diagnosis of gestational diabetes in pregnancy, particularly if they don’t have any risk factors. Many women aren’t aware that this is a possibility. ACOG—which is the American College of Obstetrics and Gynecology—recommends universal screening meaning every woman who is pregnant should have some type of screening for diabetes. Based on what that individual’s risk factors look like, the standard screen happens maybe around the sixth month of pregnancy right around 24 to 26 weeks of pregnancy. That involves taking some type of glucose tolerance test where a woman will drink an additionally sugary drink and have their blood sugar tested an hour or two hours after they drink that drink to see how their body handles that sugar load.
Host: That’s very helpful advice. I want to dig into a little bit more about being diabetic during pregnancy. How do certain types of diabetes complicate pregnancy? Then furthermore what treatments may be available for pregnant women who are diabetic?
Erin: So having preexisting diabetes—meaning if you have type 1 or type 2 diabetes when you actually conceive and get pregnant—that increases your risk for having a birth defect by about 10%. So it is a significant risk factor. Then in general whether it’s preexisting diabetes or gestational diabetes, the complications in pregnancy are fairly significant. It includes increased risk for pre-eclampsia which is a blood pressure problem that really can only be treated by delivery of the baby. There are increased risks for growth problems with the baby. A woman with poorly controlled diabetes can grow too big of a baby and conversely sometimes they can grow too small of a baby because the placenta isn’t working as well as we would like it to. There are problems with increased amniotic fluid levels, the fluid that’s around the baby. Increased risks for placental failure and stillbirth. Then in general the bigger the baby is, the higher the risks are for a woman to need an operative delivery such as c-section or potentially a difficult vaginal delivery which can cause trauma to the mother or the baby. So it is really of the utmost important to have a woman who has diabetes be really well controlled during their pregnancy to try to minimize the risks of those complications.
Host: Okay. So let’s talk about that control and some of the treatments that are available to them to minimize anything going wrong in the pregnancy.
Erin: Insulin is considered the mainstay or the gold standard of treatment in pregnancy. So for women who come to us with preexisting diabetes, if they're already on insulin that’s generally a good thing. Insulin needs will sometimes go up or down depending on the trimester of the pregnancy. Typically it requires a woman to check their blood sugar multiple times a day. We usually have our patients checking four times a day, monitoring their blood sugars, keeping a log of what they're eating, what their blood sugar readings are. Some women who are preexisting diabetic or just gestational diabetic are able to keep their blood sugars within goal with just strict diet changes. Medical nutrition therapy is sort of the fancy word for nutrition counselling. So intense nutrition counselling and helping the woman choose the right combination of carbohydrate and protein and fat can sometimes help without any medication. If a woman is not on medication and they require medication during pregnancy, again insulin is generally the first choice. Although, we are able to use an oral medication called Metformin which is quite commonly used outside of pregnancy in people who have type 2 diabetes. It works well in terms of helping a person use their own insulin a little better and kind of overcome some of that insulin resistance.
Host: Got it. So it does seem like there is a comprehensive set of measures that are available to help reduce the risk of complication if you are diabetic. Is that correct?
Erin: Correct. Along with the management from a medication side or a dietary side, we increased the surveillance of mom and baby during pregnancy to be on the lookout for some of those complications. They will frequently get additional ultrasounds to check on the growth of the baby. They will have a special detailed ultrasound to look for any sign of birth defect or fetal stress defect that can be caused from elevated blood sugars. Women who come to us with preexisting diabetes will generally get what’s called a fetal echocardiogram looking particularly at the baby’s heart since we know diabetes increases the risk for heart structure anomalies. Then towards the end of pregnancy, we generally do some type of weekly or often twice weekly surveillance checking in on that baby and placental function and making sure the baby is well oxygenated and doing well.
Host: Just as we start to wrap up here, I'm curious as to some of the questions that you mainly get from the patients that come in that you’d like to share and address to our listeners.
Erin: Sure. I think probably one of the most common questions—particularly for a woman who gets a diagnosis of gestational diabetes—is will I have to do this after my baby is born? Will I have diabetes after my baby is born? The short answer to that is no. Most of the time after delivery, blood sugar values return to normal and a woman’s ability to use their insulin changes for the better. It does confer an increased risk for developing diabetes later in life both for their child and for themselves. The second question we often get is will this effect my baby? It can potentially cause issues for the baby after delivery. Often times a newborn who’s been exposed to high levels of blood sugar in the last several weeks of pregnancy will have problems regulating it’s own blood sugar. Sometimes those babies need a little bit of help, and they need some extra sugar in those first couple of days after they're delivered. Then, again, the increased risks for the child themselves to develop diabetes later on life. All those complications can be mitigated by trying to maintain that healthier lifestyle and really trying to get out and get some physical activity, watch the amount of sugar and simple sugars in a person’s diet. All of that will go a long way to prevention, which I think is key.
Host: Just a final question here. You’ve seen so many different types of patients. I always like to ask the question what is the one thing that you wish your patients knew before they came to see you?
Erin: So I think in general it’s nice to know that we’re available for preconception consults to help someone get their pregnancy planned ahead of time before they decide to try to become pregnant. For diabetes in particular, I think that can be hugely important. Making sure a woman is on the right amount and kind of medication. There are medications that are used in diabetes outside of pregnancy that are not safe in pregnancy or not well studied in pregnancy. So really getting someone ramped up for a healthy pregnancy in terms of let’s work on your diet, let’s work on your medication regiment, let’s make sure you're getting some healthy physical activity so that you can be at your best for this important part in your life.
Host: Well Erin, I think that’s a perfect place to end. Such great advice. There's no need to wait. You can definitely be proactive and come in sooner. So thank you so much for your time. That’s Erin Wright, women’s health nurse practitioner with NHRMC Physician Groups Atlantic Fetal Medicine at New Hannover Regional Medical Center. Thanks for checking out this episode of healthy conversations. To learn more about the specialists and services offered at Atlantic Fetal Medicine, visit nhrmcphsyiciangroup.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from New Hannover Regional Medical Center. Thanks and we’ll see you next time.