Testing high-risk women for gestational diabetes in the first trimester of pregnancy may identify the worst cases of the condition, allowing for earlier treatment.
HONOLULU — Testing high-risk women for gestational diabetes in the first trimester of pregnancy may identify the worst cases of the condition, allowing for earlier treatment, according to a recent Kaiser Permanente study published in this month’s American Journal of Obstetrics & Gynecology.
Gestational diabetes, or diabetes during pregnancy, is a serious condition that can result in birthing complications, an increase in cesarean-section births, large babies, and an increased risk of obesity for the baby in later years.
Kaiser Permanente physicians screened obese (or high-risk) pregnant women as early as possible during the first trimester, or up to 16 weeks, of pregnancy and found that 35 percent of women diagnosed with gestational diabetes during their first trimester of pregnancy had to use insulin. That is a very high rate, more than twice as high as the rate among women who were diagnosed later, during the second trimester (when all pregnant women are screened). The hope is earlier treatment of these severe cases will improve outcomes for the mothers and their babies.
The study was authored by Keith Ogasawara, MD, maternal-fetal medicine specialist and professional chief of staff at Kaiser Permanente Hawaii, and Teresa Hillier, MD, MS, of the Kaiser Permanente Center for Health Research in Honolulu and Portland, Ore.
The researchers compared insulin use by pregnant women screened early versus those screened later. Insulin use to control blood sugar was used as an indicator of severe gestational diabetes. In less severe cases, the condition can be controlled by diet and exercise.
“We found that by screening women earlier in pregnancy, we are catching the worst cases of gestational diabetes,” said Dr. Ogasawara. “The study indicates that we likely have pregnant women in Hawaii who may already have gestational diabetes in their first trimester and even type 2 diabetes, but don’t know it because they aren’t being tested.”
The findings are especially enlightening for pregnant women in Hawaii, which has one of the nation’s highest rates of gestational diabetes, at 6 percent. By comparison, the rate of gestational diabetes for women in Oregon and Washington state is 4.4 percent. The study also showed that insulin use by women in Hawaii was higher than for women in Oregon and Washington. Nationally, gestational diabetes affects 5 percent to 6 percent of women.
Kaiser Permanente can conduct transformational health research like this in part because it has the largest private patient-centered electronic health record system in the world. The organization’s electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9.1 million patients to 17,000 physicians in 611 medical offices and 38 hospitals. It also connects Kaiser Permanente’s research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health care delivery for patients and the medical community.
The National Institutes of Health funded the study, which included data collected from 64,687 women who became pregnant between 1995 and 2010.
The Kaiser Permanente Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu and Atlanta. Visit kpchr.org for more information.
Kaiser Permanente Hawaii has provided total health to the people of Hawaii for more than 50 years, with physicians who are members of the Hawaii Permanente Medical Group, the largest multi-specialty physician group practice in the state of Hawaii. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. Visit kp.org for additional information.
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.