Mary Beth Schweigert
Caitlyn Kristich was thrilled to learn that she was pregnant. She was also scared.
Kristich had suffered two miscarriages before she was diagnosed with type 1 diabetes. At the time of her diagnosis, she learned that uncontrolled diabetes can increase the risk of pregnancy loss.
With guidance from her health care team, Kristich made lifestyle changes in order to lower her blood sugar and increase her chances of having a healthy baby. Even so, her positive pregnancy test several months later came with the fear that history would repeat itself for a third time.
A resident of Lancaster, the expectant mother received special care throughout her pregnancy from a clinic established by Penn Medicine Lancaster General Health’s Maternal-Fetal Medicine and Diabetes & Endocrinology practices. The joint clinic helps pregnant women gain better control of their diabetes while reducing the risk of complications to both mother and baby.
Diabetes during pregnancy is a growing concern. According to the U.S. Centers for Disease Control and Prevention, 1 to 2 percent of pregnant women have type 1 or type 2 diabetes. Additionally, up to 10 percent develop gestational diabetes, a condition in which blood sugar levels become high during pregnancy, potentially affecting the baby’s health and raising the mother’s risk of developing type 2 diabetes later in life.
“When a woman has diabetes, the pregnancy is automatically considered high-risk,” said Theresa Folk, a certified registered nurse practitioner (CRNP) with the Maternal-Fetal Medicine clinic. “We want to do what we can to control diabetes during pregnancy in order to reduce the risk of those complications, which can be very serious.”
Uncontrolled diabetes has well-established links to serious health conditions, including kidney and heart disease. Folk said that during pregnancy, diabetes can contribute to a number of complications, including increased risk for birth defects, pre-eclampsia, Caesarean section, pregnancy loss or stillbirth, and even maternal mortality.
CDC statistics show that from 2000 to 2010, the number of women with type 1 or type 2 diabetes before pregnancy increased 37 percent, while the number of pregnant women who developed gestational diabetes climbed 56 percent.
The joint clinic opened in fall 2018, with a mission to streamline care and enhance patient experience for high-risk mothers with diabetes or glucose intolerance. The clinic has served 120 women to date, and recently expanded its hours to accommodate more patients.
Offering extended appointments and regular monitoring, the clinic aims to help expectant mothers achieve and maintain optimal A1C – or average blood sugar – levels, which measure the effectiveness of diabetes treatment. Since opening its doors, the clinic’s patients have seen an average A1C decrease of 18.3 percent.
At the time of her diagnosis in 2018, Kristich, now 31, had an A1C of 14 percent – double the level generally recommended for people with diabetes. With guidance from Mallory Hull, CRNP, a certified registered nurse practitioner with Diabetes & Endocrinology, Kristich made changes that included weighing carbohydrates on a food scale and adjusting the alarm on her continuous glucose monitor to enable quicker action to stabilize her blood sugar.
Kristich maintained an A1C of 4.6 to 5.3 percent throughout her pregnancy. In November, she gave birth to a healthy baby girl.
“Pregnancy can be a very motivating time for women to gain control of their diabetes,” Hull said. “They want the best outcome for their baby. The clinic gives us an opportunity to help these women give birth to healthy babies while also improving their own long-term health.”
Ideally, she said, diabetes will be well-controlled before pregnancy, when additional variations in blood sugar levels commonly occur. The clinic enables earlier involvement in an expectant mother’s care, as well as preconception counseling for diabetic women contemplating pregnancy.
Women with diabetes typically would see perinatology and endocrinology clinicians for separate appointments, often in different locations, throughout their pregnancy. The clinic combines those multiple appointments into a single visit, increasing convenience during what can be a busy and stressful time for expectant mothers.
Visits are scheduled monthly at first, with increasing frequency as pregnancy progresses. Clinicians monitor patients’ continuous glucose monitor readings remotely between visits and check in regularly with suggested adjustments.
The clinic’s team also works with patients on a plan for insulin therapy during and immediately after labor and delivery, when blood sugar levels tend to fluctuate. Patients attend a postpartum visit several weeks after delivery, and most continue to visit Diabetes & Endocrinology for regular follow-up care.
Patient Casey Eisenberger, 27, has lived with type 1 diabetes since childhood. She was referred to the clinic early in her pregnancy, with an A1C of 7.2 percent. Based on data from her continuous glucose monitor and suggestions from Hull, the Lancaster mother-to-be took a more mindful approach to her diet and regular walks throughout her pregnancy.
By the time of her delivery, Eisenberger’s A1C had dropped to 5.7 percent. Despite developing pre-eclampsia and additional complications unrelated to diabetes, she gave birth to a healthy baby girl via C-section in November.
“It can be so scary to have a high-risk pregnancy,” she said. “The team at the clinic was very thorough, and they made me feel comfortable. I was so at peace with my care.”