Find care now
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Soon-to-be-published research examines the benefits of integrating gestational diabetes services with maternal and infant care.
Diabetes during pregnancy is common and challenging to manage because of frequent appointments for dietary/lifestyle and insulin/medication adjustments. Diabetes mellitus confers unique risks during the perinatal period, contributing to maternal, fetal, and neonatal morbidity and mortality. Combining diabetes education and management services with obstetrical care offers key advantages for birthing individuals.
Studies have shown that about 6.9% of pregnant people in the U.S. are diagnosed with Gestational Diabetes (GDM) each year. During pregnancy, the placenta produces hormones. These hormones also cause the body to become more resistant to insulin, the hormone that regulates blood sugar.
GDM can also increase the risk of developing high blood pressure and preeclampsia, a severe complication. Studies have shown that birthing people with GDM are almost 18% more likely to deliver prematurely.
Factors that put pregnant people at higher risk for developing gestational diabetes include:
- Asian, Indian, and Black ethnicity
- Family history of diabetes
- Obesity
As the fetus grows, insulin resistance can worsen as blood sugar levels fluctuate weekly. Endocrinologists who treat diabetes are overwhelmed with patients, which can lead to patients not starting insulin treatment or infrequent medication adjustments, resulting in substandard or no gestational diabetes care. Pregnant people who have gestational diabetes are 50% more likely to develop type 2 diabetes in their lifetime than people who don’t.
Our research shows integrating diabetes education and management with women’s and infant services through collaborative teamwork and holistic care can help more patients get the timely gestational diabetes care they need.
How the IP-DEMP improves diabetes care.
An integrated perinatal diabetes education and management program (IP-DEMP) helps patients understand and manage diabetes by streamlining the process. It supports their holistic health by collaborating with obstetrics, midwifery, maternal-fetal medicine providers, nurse navigators, social workers, the perinatal law team, and others to improve maternal and fetal outcomes for our patients.
As part of the D.C. Safe Babies Safe Moms Program, IP-DEMP is based on principles of diabetes self-management education and support (DSMES), which emphasize seven self-care behaviors:
- Being active
- Healthy coping
- Healthy eating
- Monitoring
- Problem-solving
- Reducing risks
- Taking medication
The program is a collaborative effort between providers and patients to:
- Reduce the time between referral and first appointment with a certified diabetes care and education specialist (CDCES)
- Improve communication between prenatal providers and CDCES’ about care plans and recommendations
- Facilitate follow-up during the postpartum period after delivery
The care team includes two certified diabetes care and education specialists. A maternal-fetal medicine physician meets with the team regularly to update management plans and provide clinical support. Providers and IP-DEMP team members communicate through the electronic medical record system and meet with patients as needed to support shared decision-making.
Appointments are a mix of in-person and telehealth visits to accommodate birthing individuals, with over 90% attending appointments. Patients receive information about gestational diabetes, risks of hyperglycemia during pregnancy, how and why to monitor blood sugar, meal planning, and the impact of diet and exercise on managing glucose.
In the postpartum period, gestational diabetes can increase a birthing person’s risk of developing type 2 diabetes and postpartum depression. The IP-DEMP continues after delivery to ensure patients with GDM complete a postpartum glucose tolerance test or patients with pre-existing diabetes receive a referral to Endocrinology if they are not already engaged in care. The IP-DEMP also partners with a postpartum health coaching service to support patients for up to a year postpartum to reach their personal health goals.
IP-DEMP patients come to learn that their participation in the program is what makes it effective. They are responsible for taking insulin, monitoring blood sugar, staying active, and choosing nutritious foods. Working together and partnering with our patients allows us to build rapport and trust, increase education, and improve outcomes.
Related reading: Chatbot Connects New Moms with Timely Infant and Maternal Care.
Next steps for improving outcomes.
This research on the IP-DEMP, soon to be published, demonstrates that a collaborative approach produces the best results for our patients. Yet there is more work to do.
For instance, Medicaid does not cover DSMES services in 17 states and the District of Columbia. There are limits on coverage of testing supplies, and challenges and restrictions make it difficult to access medications. Our patients are much more likely to use public insurance, so we’re working with the Association of Diabetes Care and Education Specialists and other organizations to work for change.
Programs like the IP-DEMP play an essential role in helping patients manage gestational diabetes in the face of many challenges. Timely referrals, co-located services, and telemedicine appointments all produce high levels of patient engagement. Navigation services and care coordination help patients access the care they need, and postpartum follow-up extends care after delivery when risks linger.
This research indicates that integrated perinatal diabetes education and management can play a critical role in helping more birthing individuals stay healthy and be active participants in their children’s lives and their communities.
