Diabetes in Pregnancy
5-10% of pregnant women will develop “gestational diabetes,” meaning they did not already have diabetes. Whether pre-existing or gestational, diabetes in pregnancy requires careful management for the health of mother and child. Ashley Battarbee, MD, whose research expertise is diabetes in pregnancy, joins Dr. Huh to discuss the major concerns and methods for controlling the disease. Diet and lifestyle interventions, insulin shots, and oral medications, along with continuous glucose monitoring, may lower the risk of complications—C-section and birth trauma for the mother, and jaundice and low blood sugar for the child. Find out which pregnant women might need to be referred to a diabetes-in-pregnancy clinic.
Featuring:
Learn more about Ashley Battarbee, MD
Ashley Battarbee, MD
Ashley Battarbee, MD Specialties include Maternal and Fetal Medicine and Obstetrics and Gynecology.Learn more about Ashley Battarbee, MD
Transcription:
Dr Warner Huh (Host): Hello. This is Dr. Warner Huh, the Chair of Obstetrics and Gynecology at the University of Alabama at Birmingham and I'd like to welcome you to this monthly episode of Women's Health with Dr. Huh.
Today, we're going to talk about something different. We're going to talk about diabetes in pregnancy. And I think for some of our listeners, this is a highly relevant and important topic in women's health and the diagnosis and management of diabetes in pregnancy is important, not just for maternal outcomes or outcomes for the mother, but also outcomes for the fetus or the baby as well. And what I'm super excited about today is our guest is a true expert in this area. And with me today is Dr. Ashley Battarbee, who is an Assistant Professor in the Division of Maternal-Fetal medicine here at UAB. She's also a James Pittman scholar, which is a really a prestigious award given to young faculty who developed truly promising careers in research. So first off, welcome, Dr. Batterbee.
Dr Ashley Batterbee: Thank you so much for having me.
Dr Warner Huh (Host): And then secondly, congratulations on your Pittman Scholarship Award.
Dr Ashley Batterbee: Thank you.
Dr Warner Huh (Host): So let's talk about diabetes in pregnancy. So obviously, there are women who have pre-existing diabetes who get pregnant, and then there are also women who are diagnosed with diabetes during pregnancy, what we often call as gestational diabetes. How often is gestational diabetes diagnosed? And can you explain how OBs diagnose diabetes during pregnancy?
Dr Ashley Batterbee: So, whereas pregestational diabetes complicates about 1% to 2% of all pregnancies, gestational diabetes occurs much more common, approximately 5% to 10% of all pregnancies, which equates to thousands of pregnancies in the US each year. We diagnose gestational diabetes, a little bit different in pregnancy than a lot of times a primary care provider might be screening for diabetes outside of pregnancy with just a blood test to check things like hemoglobin A1c. In pregnancy, we do what's called an oral glucose tolerance test or challenge test where the mom has to drink a beverage and then have her blood checked at a series of either one-hour for a screening test or three times over three hours to confirm the diagnosis if the one hour is abnormal. So it is definitely a more involved test than outside of pregnancy.
Dr Warner Huh (Host): And I think some of our listeners would want to know, I mean, so why is the diagnosis important? What are the consequences of undiagnosed or poorly controlled diabetes during pregnancy?
Dr Ashley Batterbee: So that's a really important question. And honestly, I think sometimes we miss the mark on this a little bit. Back when gestational diabetes was first created back in the 1960s, the intent was actually to try and figure out who was going to develop type 2 diabetes later in life. So really, I think the most important thing is to try and provide some risk stratification, because one in two patients with gestational diabetes will develop type 2 diabetes, which has lifelong consequences. But specifically with regard to pregnancy, it can have increased risk of complications for both the mom and the baby. Moms have an increased risk of things like preeclampsia and C-section. The baby can grow to be too large if mom's blood sugars are not well-controlled and be at risk for things like birth trauma, low blood sugar after birth and jaundice.
Dr Warner Huh (Host): How do we typically manage this? I'm assuming that there are probably some women that are just managed with diet, I'm assuming some patients with diet with medication. Can you just give us a synopsis, an overview, how we manage patients with diabetes in pregnancy?
Dr Ashley Batterbee: So really the key to management is controlling blood sugar. And you're right, that first we start with just lifestyle changes, so changes in diet, increasing exercise. And if we're able to control blood sugar with those interventions, then that's all we need. If blood sugar is still not well controlled, then we can use medications. Our first line is typically insulin, because it's has more ability to mimic the body's own production of insulin, which is not working. And then in certain situations, we might consider oral medications, things like metformin are starting to be used more.
Dr Warner Huh (Host): And I know you briefly mentioned this earlier, but I want the listeners to understand this carefully. So you mentioned again, there is a risk women having potentially lifelong diabetes after being diagnosed with gestational diabetes. But what exactly is that risk and percentage again for women?
Dr Ashley Batterbee: So it does vary a little bit based on the population. Kind of overall I'll often tell patients it's, you know, a one in two risk or 50% risk. Some studies have shown that it can be as high as up to 70% of patients having type 2 diabetes sometime later in life.
Dr Warner Huh (Host): Wow. I did not realize it was that high. So this is obviously, I'm sure you agree, a big deal for why we need to properly diagnose this and manage this plus education.
Dr Ashley Batterbee: Yes. And trying to make sure that patients have adequate follow-up after pregnancy is just a as important.
Dr Warner Huh (Host): So I know that you've dedicated your academic career to this topic and you have research funding in this area. I thought the listeners might be interested, are there any exciting developments or observations in this area of diabetes in pregnancy, either from your research or otherwise?
Dr Ashley Batterbee: So I think talking about what's most important, and we just mentioned that controlling blood sugar is key to management of diabetes. I think one of the most exciting new things that have come along is continuous glucose monitoring. So whereas a lot of patients without that are having to do a fingerstick to measure their blood sugar level multiple times every single day, continuous glucose monitoring provides a much easier way to do so. It's a little device with a sensor that sits right underneath the skin and can measure a blood sugar level every five minutes. It also has the ability to tell you when your blood sugar is getting too high or starting to get too low. So you can hopefully be a little bit more proactive in things like adjusting your diet or, if you have insulin, administering more insulin as needed. And so I think that's one of newer things that's on the horizon. A lot of our patients have found that it's much easier than trying to remember to check fingersticks and bring that blood sugar log in with them to all their visits. And also it's shown to improve outcomes. And so in patients with type 1 diabetes who used continuous glucose monitoring, their babies were not as big at birth, they had less chance of going to the intensive care unit, so definitely a lot of promise for future care.
Dr Warner Huh (Host): I will self-admit that I'm sort of at biohacker. I always kind of want to know what's going on. So I've actually worn a CGM or continuous glucose monitor myself just to understand how diet changes my blood sugar. And it's amazing what you learn. So I can imagine in this particular area that the knowledge gained and titrating what you eat and medications is actually fairly profound.
Dr Ashley Batterbee: Yeah. I think it's really going to change how we care for diabetes, both during and outside of pregnancy.
Dr Warner Huh (Host): So I guess this is a question that we commonly get at least from our referring providers, but I think patients and listeners might want to know this too. So when should pregnant women with diabetes consider getting a second opinion and/or seeing a specialist? That topic seems to come up quite a bit, but I'm sure that you have an opinion on this.
Dr Ashley Batterbee: Definitely. So first of all, anyone with diabetes outside of pregnancy should be able to get preconception care before pregnancy, so should be able to talk to a doctor about what it would look like if they got pregnant with their diabetes, what medications they could continue, as well as kind of what to expect. The other thing during pregnancy, diabetes is one of the most challenging medical conditions that we deal with in pregnancy because of the need for frequent monitoring and medication titration. And so I think anytime a provider is not comfortable with managing a patient, which is often our patients with gestational diabetes who have failed diet and exercise, or really just anyone who wants a second opinion, we've got a great diabetes and pregnancy clinic here that has a multidisciplinary team with certified diabetes educators and registered dieticians that can really provide a comprehensive visit even just for a one-time consult. And so we're happy to see patients for the duration of pregnancy and also just to give recommendations.
Dr Warner Huh (Host): So, can you just expand upon your comment about preconceptual counseling and why that's important to share with women that already have pre-existing diabetes, why that visit is so important?
Dr Ashley Batterbee: It's important for a couple of reasons. Number one, some of the medications that patients may be on for their diabetes outside of pregnancy, we wouldn't want to continue in pregnancy. And so sometimes discontinuing those early on and finding an insulin regimen that will work that could be continued in pregnancy can be helpful. But I think the most important is just to make sure that we have good control of their diabetes before they get pregnant, especially with pregestational diabetes, high blood sugar levels early in pregnancy when you may not even know that you're pregnant can cause birth defects or even cause miscarriage. And so being able to talk to a provider to get your diabetes in order before you get pregnant can be extremely helpful.
Dr Warner Huh (Host): Any closing thoughts or comments that you want to share with our patients and listeners, Dr. Batterbee?
Dr Ashley Batterbee: You know, I think we talked about it earlier. It's fortunately not a very common condition, but it's just continuing to become more prevalent, both gestational and pregestational diabetes. And we think it's going to continue to rise. The projections have shown it may increase by 50% over the next 20 years, which is just something that we're going to have to make sure we're paying close attention, to giving patients the care they need during pregnancy and plugging them into care for lifelong disease postpartum.
Dr Warner Huh (Host): That's great. Again, I'd like to thank Dr. Batterbee for updating us on diabetes and pregnancy. I always learn a huge amount from our faculty. And yet again, today was no exception.
So as always please rate this podcast and we welcome any comments, particularly on topics that you are interested in. And for more information on our obstetrical services and expertise and all clinical services that UAB Medicine provides, please check out medicine.org.
So until next time, thank you, you all. Be safe and have a great day. Take care. Peace out.
Dr Warner Huh (Host): Hello. This is Dr. Warner Huh, the Chair of Obstetrics and Gynecology at the University of Alabama at Birmingham and I'd like to welcome you to this monthly episode of Women's Health with Dr. Huh.
Today, we're going to talk about something different. We're going to talk about diabetes in pregnancy. And I think for some of our listeners, this is a highly relevant and important topic in women's health and the diagnosis and management of diabetes in pregnancy is important, not just for maternal outcomes or outcomes for the mother, but also outcomes for the fetus or the baby as well. And what I'm super excited about today is our guest is a true expert in this area. And with me today is Dr. Ashley Battarbee, who is an Assistant Professor in the Division of Maternal-Fetal medicine here at UAB. She's also a James Pittman scholar, which is a really a prestigious award given to young faculty who developed truly promising careers in research. So first off, welcome, Dr. Batterbee.
Dr Ashley Batterbee: Thank you so much for having me.
Dr Warner Huh (Host): And then secondly, congratulations on your Pittman Scholarship Award.
Dr Ashley Batterbee: Thank you.
Dr Warner Huh (Host): So let's talk about diabetes in pregnancy. So obviously, there are women who have pre-existing diabetes who get pregnant, and then there are also women who are diagnosed with diabetes during pregnancy, what we often call as gestational diabetes. How often is gestational diabetes diagnosed? And can you explain how OBs diagnose diabetes during pregnancy?
Dr Ashley Batterbee: So, whereas pregestational diabetes complicates about 1% to 2% of all pregnancies, gestational diabetes occurs much more common, approximately 5% to 10% of all pregnancies, which equates to thousands of pregnancies in the US each year. We diagnose gestational diabetes, a little bit different in pregnancy than a lot of times a primary care provider might be screening for diabetes outside of pregnancy with just a blood test to check things like hemoglobin A1c. In pregnancy, we do what's called an oral glucose tolerance test or challenge test where the mom has to drink a beverage and then have her blood checked at a series of either one-hour for a screening test or three times over three hours to confirm the diagnosis if the one hour is abnormal. So it is definitely a more involved test than outside of pregnancy.
Dr Warner Huh (Host): And I think some of our listeners would want to know, I mean, so why is the diagnosis important? What are the consequences of undiagnosed or poorly controlled diabetes during pregnancy?
Dr Ashley Batterbee: So that's a really important question. And honestly, I think sometimes we miss the mark on this a little bit. Back when gestational diabetes was first created back in the 1960s, the intent was actually to try and figure out who was going to develop type 2 diabetes later in life. So really, I think the most important thing is to try and provide some risk stratification, because one in two patients with gestational diabetes will develop type 2 diabetes, which has lifelong consequences. But specifically with regard to pregnancy, it can have increased risk of complications for both the mom and the baby. Moms have an increased risk of things like preeclampsia and C-section. The baby can grow to be too large if mom's blood sugars are not well-controlled and be at risk for things like birth trauma, low blood sugar after birth and jaundice.
Dr Warner Huh (Host): How do we typically manage this? I'm assuming that there are probably some women that are just managed with diet, I'm assuming some patients with diet with medication. Can you just give us a synopsis, an overview, how we manage patients with diabetes in pregnancy?
Dr Ashley Batterbee: So really the key to management is controlling blood sugar. And you're right, that first we start with just lifestyle changes, so changes in diet, increasing exercise. And if we're able to control blood sugar with those interventions, then that's all we need. If blood sugar is still not well controlled, then we can use medications. Our first line is typically insulin, because it's has more ability to mimic the body's own production of insulin, which is not working. And then in certain situations, we might consider oral medications, things like metformin are starting to be used more.
Dr Warner Huh (Host): And I know you briefly mentioned this earlier, but I want the listeners to understand this carefully. So you mentioned again, there is a risk women having potentially lifelong diabetes after being diagnosed with gestational diabetes. But what exactly is that risk and percentage again for women?
Dr Ashley Batterbee: So it does vary a little bit based on the population. Kind of overall I'll often tell patients it's, you know, a one in two risk or 50% risk. Some studies have shown that it can be as high as up to 70% of patients having type 2 diabetes sometime later in life.
Dr Warner Huh (Host): Wow. I did not realize it was that high. So this is obviously, I'm sure you agree, a big deal for why we need to properly diagnose this and manage this plus education.
Dr Ashley Batterbee: Yes. And trying to make sure that patients have adequate follow-up after pregnancy is just a as important.
Dr Warner Huh (Host): So I know that you've dedicated your academic career to this topic and you have research funding in this area. I thought the listeners might be interested, are there any exciting developments or observations in this area of diabetes in pregnancy, either from your research or otherwise?
Dr Ashley Batterbee: So I think talking about what's most important, and we just mentioned that controlling blood sugar is key to management of diabetes. I think one of the most exciting new things that have come along is continuous glucose monitoring. So whereas a lot of patients without that are having to do a fingerstick to measure their blood sugar level multiple times every single day, continuous glucose monitoring provides a much easier way to do so. It's a little device with a sensor that sits right underneath the skin and can measure a blood sugar level every five minutes. It also has the ability to tell you when your blood sugar is getting too high or starting to get too low. So you can hopefully be a little bit more proactive in things like adjusting your diet or, if you have insulin, administering more insulin as needed. And so I think that's one of newer things that's on the horizon. A lot of our patients have found that it's much easier than trying to remember to check fingersticks and bring that blood sugar log in with them to all their visits. And also it's shown to improve outcomes. And so in patients with type 1 diabetes who used continuous glucose monitoring, their babies were not as big at birth, they had less chance of going to the intensive care unit, so definitely a lot of promise for future care.
Dr Warner Huh (Host): I will self-admit that I'm sort of at biohacker. I always kind of want to know what's going on. So I've actually worn a CGM or continuous glucose monitor myself just to understand how diet changes my blood sugar. And it's amazing what you learn. So I can imagine in this particular area that the knowledge gained and titrating what you eat and medications is actually fairly profound.
Dr Ashley Batterbee: Yeah. I think it's really going to change how we care for diabetes, both during and outside of pregnancy.
Dr Warner Huh (Host): So I guess this is a question that we commonly get at least from our referring providers, but I think patients and listeners might want to know this too. So when should pregnant women with diabetes consider getting a second opinion and/or seeing a specialist? That topic seems to come up quite a bit, but I'm sure that you have an opinion on this.
Dr Ashley Batterbee: Definitely. So first of all, anyone with diabetes outside of pregnancy should be able to get preconception care before pregnancy, so should be able to talk to a doctor about what it would look like if they got pregnant with their diabetes, what medications they could continue, as well as kind of what to expect. The other thing during pregnancy, diabetes is one of the most challenging medical conditions that we deal with in pregnancy because of the need for frequent monitoring and medication titration. And so I think anytime a provider is not comfortable with managing a patient, which is often our patients with gestational diabetes who have failed diet and exercise, or really just anyone who wants a second opinion, we've got a great diabetes and pregnancy clinic here that has a multidisciplinary team with certified diabetes educators and registered dieticians that can really provide a comprehensive visit even just for a one-time consult. And so we're happy to see patients for the duration of pregnancy and also just to give recommendations.
Dr Warner Huh (Host): So, can you just expand upon your comment about preconceptual counseling and why that's important to share with women that already have pre-existing diabetes, why that visit is so important?
Dr Ashley Batterbee: It's important for a couple of reasons. Number one, some of the medications that patients may be on for their diabetes outside of pregnancy, we wouldn't want to continue in pregnancy. And so sometimes discontinuing those early on and finding an insulin regimen that will work that could be continued in pregnancy can be helpful. But I think the most important is just to make sure that we have good control of their diabetes before they get pregnant, especially with pregestational diabetes, high blood sugar levels early in pregnancy when you may not even know that you're pregnant can cause birth defects or even cause miscarriage. And so being able to talk to a provider to get your diabetes in order before you get pregnant can be extremely helpful.
Dr Warner Huh (Host): Any closing thoughts or comments that you want to share with our patients and listeners, Dr. Batterbee?
Dr Ashley Batterbee: You know, I think we talked about it earlier. It's fortunately not a very common condition, but it's just continuing to become more prevalent, both gestational and pregestational diabetes. And we think it's going to continue to rise. The projections have shown it may increase by 50% over the next 20 years, which is just something that we're going to have to make sure we're paying close attention, to giving patients the care they need during pregnancy and plugging them into care for lifelong disease postpartum.
Dr Warner Huh (Host): That's great. Again, I'd like to thank Dr. Batterbee for updating us on diabetes and pregnancy. I always learn a huge amount from our faculty. And yet again, today was no exception.
So as always please rate this podcast and we welcome any comments, particularly on topics that you are interested in. And for more information on our obstetrical services and expertise and all clinical services that UAB Medicine provides, please check out medicine.org.
So until next time, thank you, you all. Be safe and have a great day. Take care. Peace out.