Gestational diabetes: Pharmacists can help educate and counsel women

Rising rates of gestational diabetes warrant an increased effort from pharmacists and other healthcare professionals to raise the awareness of pregnant women. So contends Assiamira Ferrara, M.D., Ph.D., division of research, Kaiser Permanente, Oakland, Calif., and affiliate assistant professor, department of epidemiology, University of Washington.

According to the American Diabetes Association (ADA), gestational diabetes affects about 4% of all pregnant women-about 135,000 cases in the United States each year. It is one of the top health concerns related to pregnancy.

A recent study by Kaiser Per-manente researchers involving 267,000 women of various ethnic groups found that the incidence of gestational diabetes mellitus (GDM) increased 35% from 1991 to 2000.

For pregnant women, GDM can triple the risk that their children will have diabetes, as well as increase the risk that their daughters will have gestational diabetes. Children who are born to women with GDM can be abnormally large and can require birth by Cesarean section, she said.

"The children of women with gestational diabetes are more likely to be premature, to have hypoglycemia, or to have severe jaundice at birth," explained Ferrara. "Also, the mothers who have GDM need closer monitoring during their pregnancies to make sure no complications threaten their health or the health of their children."

The study found the incidence of the disease is increasing more rapidly in younger women. "While we didn't track body mass in these women, it's well known that GDM is more likely to show up in a woman who is overweight or obese. If we can help women keep their weight at healthy levels, and control their glycemic levels, we may be able to stop what could otherwise be a rapid increase in the incidence of diabetes in general," Ferrara said.

The pharmacist role Pharmacists should ask pregnant women if they are receiving adequate prenatal care from a physician, said Monique Hedderson, MPH, a researcher with the Kaiser Permanente division of research, and coauthor of the study. One of the main complications of GDM is an excessively large baby at delivery, and these babies can have serious birth trauma because they are so large.

The Centers for Disease Control & Prevention reports that 25% of pregnant women have less than adequate prenatal care. If these women have GDM, they may be in danger.

According to Hedderson, GDM is not always easy for a pregnant woman to detect. Gestational diabetes does not always have symptoms, she explained, and the woman wouldn't necessarily know she has GDM unless she has her glucose screened. If the woman goes unscreened, she doesn't know that the baby is too large or in danger of complications.

Monitoring and insulin If a woman has already been diagnosed with GDM, a pharmacist can encourage her to continue seeking prenatal care and to follow the recommended regimen. For example, doctors often recommend that women with GDM home monitor their blood glucose levels to make sure their condition is under control.

"Usually, the first line of attack is a diet and exercise program," Hedderson noted. "The woman will be advised to see a dietician. In order to determine if the program is effective, she needs to strip-monitor her blood glucose on a daily basis. If it seems the program is not working, the next line of attack is to prescribe insulin." Because R.Ph.s are often the ones who sell home monitor blood glucose tests to patients, they can advise them to follow the advice of their dietician and monitor their blood glucose on a regular basis as recommended by their doctor, she added.