Two An Interactive Model Program of Care for Diabetic Women Before and During Pregnancy

Abstract

Pregnancy complicated by insulin-dependent diabetes mellitus is recognized as a cause of maternal morbidity, congenital malformations, intrauterine fetal death, neonatal morbidity, and neonatal death. The incidence and severity of these complications is directly related to the duration of diabetes and the degree of hyperglycemia both prior to and during pregnancy. Therefore, a thorough discussion of complications, risks, and required management should be provided to all diabetic women and their partners so that informed and responsible decisions regarding pregnancy can be made. This article will present a cooperative program of care including specific information on essential educational components.The San Francisco Bay Area Diabetes and Early Pregnancy Program was conceived as an interdisciplinary, interactive team approach to the education and management of insulin-dependent diabetic women prior to and during pregnancy. The program focuses on achieving perinatal survival and preventing as many of the complications as possible. Our method for achieving this is through appropriate diabetes and pregnancy management, intensive patient education, and active patient participation. (See Figure 1.) Three components are essential for an interactive program of patient education and management to be successful.1. All team members (diabetes educators, perinatal nurses, nutritionists, social workers, and physicians) are educated to the possible complications and the new methods of management used to prevent them.2. We, as health care providers, must be consistent and supportive in our interventions. 3. The diabetic woman and her partner must become primary members of the healthcare team.As active participants in healthcare it is imperative that Figure I Diagram of Educational Model each woman and her family be provided the necessary information required to: 1) achieve effective behavioral change and improve selfcare, 2) make appropriate adjustments at home for the control of diabetes, and 3) seek adequate and appropriate healthcare as indicated for both diabetes and pregnancy.Since we know that active patient participation is essential for the success of a pregnancy complicated by diabetes, our education and management program emphasizes advantages, disadvantages, consequences, and benefits of various courses of action, in order to stimulate and more thoroughly involve women in making appropriate healthcare choices.