Diabetes and Pregnancy: Expert Attention and Care Bring a Sweet Delivery
Matthew J. Kim
Chief, Maternal/Fetal Medicine, Danbury Hospital
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When Alisa D'Andrea learned that she had gestational diabetes in 2012, she worried that her plans for a drug-free, natural childbirth were out the window. Disappointed but undeterred by her "high-risk" status, the Hamden mother of two was referred by her obstetrician/gynecologist to Judy Gibney, RN, Maternal/Child Health Supervisor with Western Connecticut Home Care (WCHC) and instructor for the Sweet Delivery Program.
Sponsored by a two-year, $40,000 March of Dimes grant awarded to WCHC, the Sweet Delivery Program provides free education and case management to women with gestational diabetes to help control blood sugar levels and promote healthy outcomes for mother and baby. Led by Medical Director Matthew Kim, MD, Chief of Maternal/Fetal Medicine at Danbury Hospital, the Sweet Delivery Program involves interactive group sessions to discuss the role of diet and activity in diabetes control, instruction in carbohydrate counting and testing of blood sugar levels, and opportunities to ask questions and request clarification. Participants monitored their blood sugar levels four times a day along with weekly reporting and follow-up with the Sweet Delivery Program instructor. They were also encouraged to contact the instructor by phone, email, or to return for further group sessions as needed. Glucose testing supplies were made available by manufacturers free of charge or covered by the patient's healthcare insurance.
Alisa wanted "a natural, medication free birth. I did not want to be induced in the hospital, which is often the case with gestational diabetic moms. I worried about how to control my blood sugar and any effects on the baby if I had to take medication," she said.
Ultimately, Alisa had a drug-free, natural, vaginal birth, welcoming a healthy baby girl; and happily, blood sugar levels for both mom and baby today are normal. "My nurse, Judy, allowed me to discover my own path rather than impose strict guidelines for me to follow. I would have stood on my head if Judy asked me to, and if it would have helped the baby. She worked with me to develop a plan to maintain my blood sugar. Judy understood what I wanted; she was my best advocate," Alisa explained.
Dr. Kim said, "The prevalence of insulin resistant diabetes, and in particular gestational diabetes, is increasing globally. Diagnosis and management of such patients continues to be challenging due to variations in care provided to pregnant women. In response, this nursing-based program can improve upon the routine for education and follow-up in the physician's office. Working side by side with these women, our team increased patient knowledge and awareness to achieve good outcomes, which require a high level of education-intensive contact."
Literature suggests the majority of gestational diabetics require only 'lifestyle' modification of diet and activity to normalize patients' glycemic profiles, rather than pharmacologic or formal medical intervention. During 2012, 75 women enrolled in the program, and 49 or 65.3 percent achieved optimal glycemic control based on national obstetrics guidelines with lifestyle modification alone. An additional 23 women or 30.7 percent required active intervention with oral diabetes medication, and three patients or 4 percent were controlled on a split-dose insulin regimen. All babies were born prior to their due dates, weighing between 5 lbs. 1 oz. and 9 lbs. 14 oz. Two infants weighed greater than 9 pounds with both mothers on medication. All infants were described as healthy. The Sweet Delivery Program was so successful at Western Connecticut Health Network that March of Dimes is looking to expand the program throughout Connecticut.
For more information about women's services and resources for high-risk pregnancy at Western Connecticut Health Network, visit online at DanburyHospital.org or call 1-800-516-4743.
About Western Connecticut Health Network
Western Connecticut Health Network is the region's premier, patient-centered health care organization serving residents of Western Connecticut and adjacent New York. The organization is anchored by two nationally recognized hospitals, Danbury Hospital and New Milford Hospital, as well as their affiliated organizations. In addition to the two hospitals, the continuum of care offered includes the following affiliates:
- Western Connecticut Medical Group, an integrated physician practice with primary and specialty care expertise
- Western Connecticut Home Care, an agency for home care and community health services
- The Western Connecticut Health Network Foundations
- emergency medical and Level II trauma services
- an occupational wellness and medicine program, providing services for business and industry
- a nationally renowned Biomedical Research Institute
Western Connecticut Health Network has centers of excellence in women's health, cardiovascular and cancer services; minimally invasive joint and spine surgery; digestive disorders, weight-loss (bariatric) surgery, and radiology and diagnostic imaging. It also offers specialized programs for neonatology with a Level IIIb neonatal intensive care unit and accredited sleep disorder centers. Both hospitals also maintain active clinical research programs, offering clinical trials for patients with cancer and other health concerns. Danbury Hospital was named a Top 100 Hospital by US News and World reports in 2012; a and a Top 100 for Value by Cleverly and Associates. New Milford Hospital is well known as a Planetree hospital and for its Plow to Plate, farm to table food program.
For more information, visit WesternConnecticutHealthNetwork.org, DanburyHospital.org; NewMilfordHospital.org and share your comments with us at Facebook.com/DanburyHospital or Facebook.com/NewMilfordHospital.
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Western Connecticut Health Network is conducting a capital campaign to meet patients' changing needs with next generation facilities, resources, talent, and technologies. Our priority areas are the Patient Tower, Emergency Department, and Neonatal Intensive Care Unit at Danbury Hospital, the Emergency Department at New Milford Hospital, and the Biomedical Research Institute. To learn more, please call the Foundation office at (203) 739-7227 or visit us at TheCampaignForWCTHN.org.