Due to the prevalence of diabetes and its related illnesses in the state of South Carolina, a program at MUSC has been developed to address diabetes and women’s health. The Department of Gynecology has developed a program to counsel patients with diabetes preconceptually, a program to follow patients who developed gestational diabetes during pregnancy after delivery and a program to care for individuals with Polycystic Ovarian Syndrome.

Preconceptual Counseling in Women with Diabetes:
Preexisting diabetes can have an adverse affect on both the women and the fetus. Exposure to maternal diabetes during the first trimester increases the risk of congenital anomalies and spontaneous abortions. The anomalies most commonly affect the central nervous system, heart, great vessels, kidneys and skeleton. The risk of anomalies correlates with the level of maternal glycemia, as shown by the hgbA1C. Women need careful monitoring prior to becoming pregnant. The goal is to ensure that the patient has self-management skills to optimize her glucose control and to have her hgb A1C concentration in a low risk range for birth defects and spontaneous abortions. Contraception is essential during this time until adequate glucose control is achieved.

Care of Women with a History of Gestational Diabetes:
Gestational diabetes occurs when women are diagnosed with glucose intolerance during pregnancy. The physiological changes in glucose metabolism during pregnancy are responsible for this. Women who have had gestational diabetes have a twofold to fivefold greater risk of diabetes after pregnancy than the general population. The risk is highest in women who have the highest glucose levels during or soon after pregnancy, women who are obese, or those who were diagnosed with gestational diabetes prior to 24 weeks gestation. Women with a history of gestational diabetes need a regular assessment of their glucose levels. They need a fasting glucose level within six months of delivery and then annually. These women will also benefit from counseling regarding reducing their risk for diabetes. This includes increased physical activity and weight reduction. Studies have shown that behavioral changes such as diet and exercise can decrease the risk of type II diabetes by 40-60 percent. Contraception is important and low dose combination oral contraceptive pills don’t increase the risk of diabetes. Patients who have had gestational diabetes need to be screened for elevated glucose levels prior to attempting another pregnancy to ensure their hgb A1C levels are in a good range.

Polycystic Ovarian Syndrome (PCOS):
Polycystic ovarian syndrome is characterized by obesity, acne, hirsutism (abnormal hair growth), infertility and irregular or absent menstrual cycles. The underlying cause of PCOS is androgen excess. Patients with PCOS are noted on ultrasound to have multiple small cysts below the cortex of their ovaries. The classic disorder starts during puberty, however, it can evolve over time. Insulin resistance has been noted in women with PCOS. This not only puts patients at increased risk for diabetes, but also for cardiovascular disease and hypertension.

When evaluating patients with PCOS, serum levels of testosterone and DHEAS (dehydroepiandrosterone sulfate) are helpful. The elevated testosterone levels may be derived from both the ovary and the adrenal gland. The DHEAS is derived from the adrenal gland. In patients with hirsutism, they may have elevated free testosterone levels. Fasting glucose and insulin levels are drawn to evaluate for insulin resistance. A lipid profile may be drawn to evaluate for underlying cardiovascular disease.

One of the first goals in treating individuals with PCOS is diet and exercise.  Studies have shown  a 10 percent decrease in weight can improve ovulation. Individuals who desire pregnancy can be treated with ovulation induction agents such as clomiphene citrate or gonadotropins. When insulin resistance has been documented, an insulin sensitizing agent such as metformin may be used. On adequate doses of metformin, women have resumed ovulation and have become pregnant. The main side effect with metformin is GI disturbance.

In women who are not trying to conceive, they frequently experience hirsutism and menstrual abnormalities. These patients are commonly treated with oral contraceptives and an antiandrogenic drug ,such as spironolactone. Medical therapy for hirsutism can take between three and six months to show effects. Electrolysis in conjunction with this medical therapy may be helpful. The spironolactone may cause birth defects, therefore oral contraceptives are also important due to this.

Why choose MUSC?
WISE Diabetic Solutions is a specialized OB/GYN clinic designed to treat women of all ages and life stages. The name of the clinic is an acronym for the formal title chosen to represent the philosophy of this diabetes specific clinic. WISE diabetic solutions characterizes our goal of providing women with Information, screening and a means of evaluation of their diabetes.

WISE diabetic solutions uses a multidisciplinary approach for the care of these patients. The clinic is staffed by a maternal fetal medicine specialist, a gynecologist, certified nurse midwife/certified diabetes educator, a nutritionist and a social worker. In patients with a history of gestational diabetes and PCOS, prevention of further disease progression is essential. By using this team approach including dietary and exercise counseling, our hope is to decrease the progression of the disease.

Program Medical Staff:
Dr. Jill Mauldin, Maternal Fetal Medicine
Laura Nance, Registered dietician
Mary Bonney, Social work

 Diabetes (Type 1, 2, and Gestational)
 

 Diabetes and Pregnancy