Clinicians should consider medication for patients with high normal BP — systolic or diastolic BP consistently above the 90th percentile for age, sex and height. These women may be candidates for medication if they are unable to reduce their BP using lifestyle changes within three to six months. Patients with hypertension should begin medication as soon as the clinician confirms the diagnosis, ADA recommendations state.
Clinicians should also consider whether the patient might be a candidate for aspirin therapy for heart disease and stroke prevention. The treatment might be appropriate in women aged older than 60 years, but it is not recommended for younger women without heart disease risk factors. The risk of bleeding may outweigh the benefits for these women, according to the ADA guidelines.
Clinicians should also encourage patient with diabetes to keep HbA1c levels less than seven percent. Currently, fewer than half of patients with diabetes meet this goal.
Proper diabetes management is particularly critical for women of childbearing age because potential complications may affect not one, but two people. This group has seen a dramatic increase in incidence of diabetes — the number of pregnant women with diabetes aged 30 years to 39 years increased 70% from 1990 and 1998, according to the CDC.
Because unplanned pregnancies are potentially troublesome, ADA guidelines recommend that clinicians routinely offer preconception counselling starting at puberty. The high incidence of unplanned pregnancies makes it important to review medications prescribed to treat diabetes, because some — such as ACE inhibitors for hypertension — are contraindicated or not recommended during pregnancy.
Women with diabetes who are planning a pregnancy should undergo a thorough evaluation for diabetic retinopathy, nephropathy and cardiovascular disease. The ADA guidelines recommend that clinicians should send women for eye exams in the first trimester, throughout pregnancy and for a year after the baby is born.
There is also special urgency when it comes to treating pregnant women who develop gestational diabetes, as it goes hand in hand with other conditions including hypertension, preeclampsia and infections.
Women with gestational diabetes are more likely to require a caesarean section because the infant may be too large for a vaginal delivery. At birth, these babies also run the risk of having hypoglycemia and breathing difficulties, according to the NDEP.
Clinicians can help ensure healthier outcomes by helping women with gestational diabetes keep blood glucose within the target range. Some key strategies recommended by the NDEP include developing a meal plan, exercising and using insulin, if necessary.
Women who develop gestational diabetes should also inform their child’s paediatrician that they had the condition, so that their child’s growth is monitored and potential problems are caught early.
Women with gestational diabetes should not only be taught to manage their condition, but also about the risk for type 2 diabetes after pregnancy. While gestational diabetes typically resolves after delivery, women with disorder have a 35% to 60% chance of developing type 2 diabetes.
The NDEP recommends that clinicians test women who have had gestational diabetes for type 2 diabetes six to 12 weeks after delivery, and at least every three years after.
Results from a 2007 study indicated that women who were overweight and sedentary were more likely to develop type 2 diabetes after gestational diabetes.2 To reduce this risk, the CDC recommends that these women participate in 150 minutes of moderate physical activity every week, follow a healthy diet and lose five to 10% of their body weight.
Clinicians need to focus on more than just a woman’s physical health to treat her diabetes. A successful approach will focus many different aspects, including social and emotional issues to get a complete picture of the patient’s health.
Kelly Bilodeau is a freelance medical writer.