Biomedical Frontiers: Fall 1997, Vol.4, No.2
Diabetes Research
Diabetes and Pregnancy

Jonathan Smith

Diabetes and pregnancy can be a dangerous combination: Soaring glucose levels can not only cause long-term complications in a pregnant woman, but also lead to birth defects and other abnormalities in her baby. Despite these problems, however, no clear treatment approach exists. For instance, some physicians hospitalize the pregnant woman to monitor her glucose levels, while others prefer to have patients check in once a month at a lab for testing. Now, a team of researchers at CPMC is investigating whether home glucose monitoring is a more effective approach to head off complications.

In a study that lasted four years and involved a team of researchers, obstetricians, and nutritionists, CPMC researchers followed 135 women with gestational diabetes who used home glucose monitoring.

Diabetes in pregnancy is associated with a high risk to the fetus. "If the glucose or sugar in the mother is too high, it's like force-feeding the baby," says Dr. Robin Goland, lead author of the study, a Florence Irving Assistant Professor of Medicine, chief of the diabetes clinic, and director of the diabetes and pregnancy program. "Our theory is that home glucose monitoring will give women more control over matching their food and activity levels and allow them to rapidly know when they need insulin. It should allow for the individualization of therapy in an outpatient setting and, ultimately, for a healthy mother and baby."

Approximately 1 percent of pregnant women develop gestational diabetes. These women are then at increased risk for adult onset diabetes later in life. In addition, as more women delay childbearing until their 30s and beyond, physicians are seeing more cases in which women with adult onset diabetes become pregnant. Like the pre-gestational juvenile diabetic, the pre-gestational adult onset diabetic requires careful management to prevent complications to mother and child.

Dr. Goland has collaborated on these studies with Mary Ann Jonaitis, RN, diabetes educator, and nutritionist; Dr. Judith Hey-Hadavi, medical resident; and the clinical obstetrics service.

If too much glucose from the mother crosses the placenta, the result can be dangerous.

The researchers hope to broaden the applications of the diabetes and pregnancy study, which was a pilot project. They plan to use patient care strategies developed in their diabetes and pregnancy study to help the large population of diabetic patients at CPMC.