Bringing Maternal Fetal Medicine Specialists and Endocrinologists Under One Roof to Treat Pregnant Women with Diabetes

By combining two specialties into one program, physicians at MUSC Women’s Health have the opportunity to guide expectant mothers with diabetes through pregnancies that might otherwise be complicated and stressful.

The Centers for Disease Control and Prevention estimates that over 10% of the overall adult U.S. population had diabetes in 2018. Although a smaller proportion of young adults are affected, 1-2% of pregnant women have type 1 or 2 diabetes at the time they become pregnant, and at least another 5% develop diabetes during the pregnancy: both situations can put the mother and baby at risk for complications.

Diabetes affects the body’s ability to process the sugars in food and turn them into energy. When people eat and digest food, sugars are absorbed into the bloodstream in the form of glucose. In response, the pancreas releases insulin, allowing the glucose to enter cells where it is turned into energy. In diabetes this delicate balance is disturbed – either the body is unable to produce enough insulin, or it is resistant to the effects of insulin, and blood glucose levels rise too high.

Whether an expectant mother is aware of her diabetes prior to pregnancy or is diagnosed after, it is immensely beneficial if she can receive MUSC’s team-based care. She needs to see both an obstetrician who specializes in high-risk pregnancies, also known as a maternal fetal medicine specialist, and a diabetes care team led by a diabetes specialist known as an endocrinologist.  Often, she needs help with anxiety or depression – which are common in complicated pregnancies – and she will need nutritional advice and eye exams. For many women, it is hard to make it to these visits in addition to their checkups that accompany any pregnancy.

At MUSC Women’s Health, the new, integrated Management of Maternal Diabetes Program (MOMs Diabetes Program), is where maternal fetal medicine specialists and endocrinologists work together to ease the burden.

“We have the opportunity to work with each other in a way that is novel and entirely different from the way care was delivered before,” said Ryan Cuff, M.D., an assistant professor in the department of obstetrics and gynecology and a maternal fetal specialist for high-risk obstetrics at MUSC.

By bringing maternal fetal medicine and endocrinology specialists under one roof, the number of clinic visits can be reduced, and patient care can be streamlined. Before the program, pregnant women with diabetes were expected to attend separate appointments with each specialist, usually in different locations and on different days. Now they can see them all together at one location. An added advantage is that providers can function more closely as a team to deliver the best care. The MOMs Diabetes Program now incorporates nutritionists, behavioral health specialists and retinal screening for diabetic eye problems into one visit.

Many specialists suggest women with diabetes who want to have children plan their pregnancies carefully. Barbara Head, M.D., one of the maternal fetal medicine with the MOMs Diabetes Program, emphasizes that the risks are greatly reduced if a patient’s diabetes is under control at the time she becomes pregnant as well as during the pregnancy. Head suggests consulting one of the program’s physicians for advice prior to becoming pregnant.

In addition to streamlining care, the team involved with the MOMs Diabetes Program is working on other ways to improve pregnancy outcomes for women with diabetes across the South Carolina Lowcountry. With the goal of tailoring each approach the circumstances of individual women, the team uses new technologies like telemedicine to support patients who face challenges related to distance, poor economic circumstances or health disparities.

By combining specialists, MUSC Women’s Health is making care more accessible to pregnant women with diabetes – all with the aim to improve the health and wellbeing of its patients.