SEATTLE, Dec. 14, 2011 – The Maternal and Fetal Specialty Center at Swedish’s First Hill campus recently expanded their comprehensive care program by adding on-site diabetes counseling to work one on one with expectant mothers. Certified Diabetes Nurse Educator Chris Pelto, R.N., C.D.E., is the primary counselor. She works closely with maternal fetal specialist Brigit Brock, M.D., who is a perinatal diabetologist. The Swedish team develops tailored treatment plans that keep food intake, exercise, and insulin in balance throughout pregnancy.
“Diabetes is so much more prevalent now and some women may not even know they have it until they are pregnant,” said Dr. Brock. “A generation ago, many health-care providers discouraged women with diabetes from becoming pregnant. But women who manage their diabetes very tightly during pregnancy can give birth to healthy babies.”
Previously, Swedish physicians referred women to the Swedish Diabetes Education Center, located in Suite 611 of the Heath Building at 801 Broadway. Now, all services are under the same roof at the Maternal and Fetal Specialty Center, which focuses on higher-risk pregnancies and is located in Suite 750 of the Nordstrom Medical Tower at 1229 Madison St.
Pelto expects to work with up to 200 pregnant women each year, including patients with Types 1 and 2 diabetes and gestational diabetes. Many of them will be working mothers and have other children, so one-stop convenience is important.
“Swedish sees this as a fully integrated service,” said Pelto. “If we make it easier for patients to get the right information and guidance during pregnancy, they are more likely to follow through on it and have healthier babies.”
A key to a successful outcome for a woman with diabetes is keeping blood glucose (sugar) in the target range, both before and during pregnancy. If blood-glucose levels are near normal from the time of conception, the risk of birth defects can be reduced to no higher than that for women without diabetes.
Patients see Pelto as part of each doctor visit. She downloads their blood-sugar levels into easy-to-read graphs, plus provides full support for proper nutrition and exercise. “Pregnancy can make the symptoms of low-blood glucose harder to detect,” she noted. “So, diabetes control requires some extra work.”
If a pregnant woman’s blood sugar is tightly controlled, that can significantly reduce the risk of miscarriage, premature delivery or stillbirth, or the possibility of birth defects. Other risks to the baby include low blood glucose at birth (hypoglycemia), prolonged jaundice and respiratory distress syndrome.
According to the American Diabetes Association (ADA), some of the possible risks to the mother include worsening of diabetes-related eye problems and kidney problems, infections of the urinary bladder and vaginal area, preeclampsia (high blood pressure usually with protein in the urine), or difficult delivery or cesarean section.
Despite recent advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk for birth defects. High blood-glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby, increasing the chance of birth defects.
Pregnant women who have never had Types 1 or 2 diabetes before but experience elevated glucose levels during pregnancy have gestational diabetes. This starts around 24 to 28 weeks of gestation when the placenta secretes hormones that unmask maternal carbohydrate intolerance and insulin resistance, resulting in blood sugars that are higher than normal. Without treatment these high blood sugars pose a threat to the fetus.
The ADA estimates that gestational diabetes is present in 18 percent of pregnancies. For the women who develop it, Swedish’s new service will make sure they are evaluated and counseled more promptly.
“Patients are in shock when they learn they have gestational diabetes,” explained Pelto. “For them, meal planning and exercise often work to keep blood-glucose levels in control. However, if levels remain high, a physician will probably start the patient on medication, such as insulin.”
Women with a history of gestational diabetes frequently develop Type 2 diabetes later in life, so patients need to be checked regularly. “Some people have the misconception that they get diabetes from eating too much sugar,” noted Dr. Brock. “But it’s usually a hereditary trait of insulin resistance that becomes more obvious during pregnancy. And it’s much more likely to appear if the woman is not at a healthy weight and isn’t physically active.”
Diet and Exercise
Specific meal planning can help women avoid high and low blood-glucose levels, while providing all the nutrients a baby needs to grow. That includes eating a wide variety of foods – vegetables, whole grains, non-fat dairy products, fruits, lean meats, poultry and fish.
“Many people think ‘eating for two’ means consuming a lot more during pregnancy than before,” said Pelto. “But most women only need to increase their calorie intake by about 300 more calories each day.”
Exercise is another key part of diabetes treatment, said Pelto. “In general, it’s not a good idea to start a new, strenuous exercise program during pregnancy. So, we can help women select the right mix of walking, low-impact aerobics, swimming or water aerobics.”
For more information
For more information, contact the Swedish Maternal and Fetal Specialty Center at 206-386-2101 or 1-800-228-9677 or visit www.swedish.org/Services/Pregnancy---Childbirth/Services/Maternal-and-Fetal-Specialty-Center.
Swedish has grown over the last 102 years to become the largest non-profit health provider in the Greater Seattle area with 11,000 employees, more than 2,800 physicians and 1,700 volunteers. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); freestanding emergency departments and ambulatory care centers in Redmond and Mill Creek; Swedish Visiting Nurse Services; and Swedish Medical Group – a network of more than 100 primary-care and specialty clinics located throughout the Greater Puget Sound area. In addition to general medical and surgical care including robotic-assisted surgery, Swedish is known as a regional referral center, providing specialized treatment in areas such as cardiovascular care, cancer care, neuroscience, orthopedics, high-risk obstetrics, pediatric specialties, organ transplantation and clinical research. For more information, visit www.swedish.org, www.swedishcares.org, www.facebook.com/swedishmedicalcenter or www.twitter.com/swedish.
In 2007, Swedish embarked upon an ambitious $100 million fundraising campaign. Campaign investments are used to support a wide variety of initiatives throughout the health-care system, including cancer, heart and vascular, women and children, neuroscience, and orthopedics as well as programs to support underserved populations. To date, the campaign has secured gifts totaling more than $87 million. For more information or to support the campaign, visit www.campaignforswedish.org.