Expert advocates for universal screening of diabetes in pregnant women

AADE 35th Annual Meeting

WASHINGTON — Diabetes is the major health care delivery problem in pregnancy and universal screening has been shown to improve clinical outcomes, Lois Jovanovic, MD, said during a presentation at the American Association of Diabetes Educators 35th Annual Meeting, held here.

As diabetes educators, “it is time to turn the tide and diagnose type 2 diabetes in pregnancy,” said Jovanovic, CEO and chief scientific officer at Sansum Diabetes Research Institute in Santa Barbara, Calif.

“If there are 5 million pregnant women each year in the United States and 8% to 10% have gestational diabetes, there are a half million women each year with diabetes in pregnancy,” said Jovanovic, an Endocrine Today editorial board member.

According to Jovanovic, more women are becoming obese at a younger age, thus increasing the risk for type 2 diabetes during child-bearing years. She presented several criteria to identify type 2 diabetes in pregnancy: elevated blood glucose based on a glucose challenge test, elevated blood pressure, HbA1c >5.3%, elevated BMI >30 (using present pregnant weight and height) and evidence of acanthosis nigricans.

“Normal glycemia before, during and after all pregnancies complicated by diabetes is possible,” she said.

Jovanovic and colleagues conducted universal screening of all pregnant women in Santa Barbara county. “We have 4,000 pregnant women per year and 10% of those women have hyperglycemia during pregnancy,” she said.

At diagnosis, Jovanovic said they monitor fasting and postprandial glucose, teach women a low-carbohydrate diet and self-management of blood glucose and decide one week later whether or not the woman needs insulin therapy. If so, they use a daily insulin requirement scale of 0.7 U/kg per day during the first trimester, 0.8 U/kg per day during the second trimester and 1 U/kg per day during the third trimester.

“Our outcomes in Santa Barbara county show that we can normalize birth weight and be cost effective,” Jovanovic said. The universal screening program has saved Santa Barbara county $2 million per year in health-related costs, according to Jovanovic. – by Katie Kalvaitis

For more information:

Jovanovic L. Diabetes during the child-bearing years. G02. Presented at: AADE 35th Annual Meeting; Aug. 6-9, 2008; Washington, D.C.