Gestational diabetes is a complication of pregnancy that, without adequate treatment, poses serious risk to both mother and baby. The obstetric team at North County Health Services' Women's Health Services has been an affiliate of the statewide Sweet Success Program for more than 10 years and provides a team approach to assure best outcomes for our patients.
Approximately 140 to 150 women are cared for every year in the Sweet Success program, representing about 7-10 percent of our prenatal population. All women are screened during pregnancy for altered glucose metabolism. Those with high risk factors -- older than 25 years, obesity, ethnicity (Latinas, blacks and Pacific Islanders all have increased lifetime risk for diabetes), or history of low birth-weight babies -- are screened early in the pregnancy.
For some women, the hormonal changes of pregnancy cause high blood sugars. In others, pregnancy unmasks an undiscovered insulin resistance suggestive of a pre-existing, undiagnosed Type II diabetes. Achieving adequate glucose control during pregnancy will affect the mother's long-term health and help her delay, if not completely avoid, a future diabetic diagnosis and its complications.
More important, babies of gestational diabetic mothers are at increased risk for obesity and diabetes themselves. Women who have well-controlled blood sugars prenatally decrease these risks for their children. Also, women who choose to breastfeed for one year further decrease risks of diabetes for themselves and their babies.
Given the epidemic of diabetes and obesity we're experiencing in this country, the opportunity to affect current and future generations is a great motivator for the Sweet Success team.
Once enrolled, women are asked to self-monitor blood glucose four times a day, eat three meals and three snacks, keep a diet log, exercise, and take medications as prescribed.
Compared with state averages for the Sweet Success program, our patients have lower educational and literacy levels, and are more often non-English speaking. Yet our outcomes match, or are superior to, all other programs statewide. This can only be explained by the team's dedication.
The leaders of the team at North County Health Services are myself and Jennifer Ikemoto, both midwives. We have become certified diabetic educators so that we can offer not only expert clinical care, but the health education and psychosocial support that contributes to successful diabetic management. Obstetricians Dr. Hector Streeter and Dr. Rahaleh Esfandiari offer crucial medical support for pregnant women who are deemed high risk.
Judy Brown, a longtime registered dietitian and certified diabetic educator, brings a wealth of experience to guide patients and clinicians. Further one-on-one support and extended teaching in blood glucose monitoring are provided by Veronica Limon, health educator.
Given the stress accompanying the lifestyle changes demanded by the program, licensed clinical social worker Josie Acosta is a critical member of the team. A recent addition has been medical assistant Deana Cortez, whose friendly reception of women at their frequent visits helps build an environment of safety and trust.
Like many of our patients, Maria, a 37-year-old woman having her fifth baby and her first born in the United States, experienced good outcomes because of care by our team. Maria was uneducated and could not read or write. Her first language was not Spanish, but a native Mexican dialect. With patience and creativity, the team worked to create a care plan for her.
Veronica successfully taught her to use a blood glucose monitor and helped her navigate the difficult and confusing world of MediCal funding, pharmacies, and other agencies. Judy used food models and pictures to create a meal plan Maria could follow. Josie cared for Maria in private and group sessions, encouraging stress management and the creation of a support system within her community. She also identified charitable organizations to assist Maria with food, necessary baby items and housing.
Frequent visits (typically twice a week in the third trimester) with Mimi and Jennifer helped Maria to adjust insulin dosing and monitor her baby's well-being, reassuring both mother and her providers that all was well. Because of Maria's lack of literacy, insulin dosing and administration provided a special challenge. Veronica created a system of pre-filling insulin syringes and color-coding them, which proved very successful.
In the end, Maria delivered a normal-weight baby and breastfed exclusively. Her postpartum glucose testing was normal, and she proudly informed the team that she intended to continue the lifestyle changes she learned for the sake of her whole family's health. That's what we call a Sweet Success!
Mimi Mateo is a midwife with North County Health Services, a private not-for-profit organization that serves more than 60,000 patients annually at 10 health centers in Carlsbad, Encinitas, Oceanside, Ramona and San Marcos, and two mobile clinics. Visit www.nchs-health.org or call (760) 736-6767.
