PowerPoint Presentation

Karin A. Fox, M.D.

By the end of this presentation, the viewer will be able to describe complications of uncontrolled diabetes in pregnancy, barriers to treatment, and current efforts to improve timely access to transitional care for diabetic women BITTERSWEET MEDICINE: DIABETES CARE IN PREGNANCY

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WOULD YOU?Leave a baby with no escape?

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CesareanUNCONTROLLED DIABETES ADVERSE OUTCOMES

Congenital heart defects

Congenital heart defects

Sirenomelia syndrome

Sirenomelia syndrome

Miscarriage

Macrosomia

Macrosomia

Shoulder Dystocia

Shoulder Dystocia

Cesarean

MiscarriageDEATH

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BARRIERS?

What percent of pregnancies are unintended?A: 80-85%B: 70-75%C: 20-45% D:10-15%

20%35%45%Adapted from: Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 19822010. National health statistics reports; no 55. Hyattsville, MD: National Center for Health Statistics. 2012.

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WHAT ABOUT PLANNED PREGNANCIES?

Uncontrolled DiabetesNauseaObesityCravings/Aversions

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Adapted from: CDC Diabetes Data & Trends: Number (in Millions) of Adults with Diabetes by Diabetes Medication Status, United States, 19972011(PREVALENCE IN millions)DIABETES PREVALENCE (U.S.A)

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RISING PREVALENCE OF DIABETES

CDC Estimate: By 2050, 1 in 3 adults will have diabetes, if current trends continue Diabetes Report Card 2012. Center for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation

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Where does the patient turn?

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Kozhimannil KB, Abraham JM, Virnig BA. National trends in health insurance coverage of pregnant and reproductive-age women, 2000 to 2009. Womens Health Issues. 2012 Mar;22(2):e135-41.HAS HEALTHCARE GOTTEN BETTER FOR WOMEN?

1.5 % per yearover10 years

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A BETTER WAY

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FAMILY PLANNING

PRECONCEPTIONAL COUNSELING

EDUCATION

PATHWAY TO PREGNANCY

HgA1CGOAL!!!

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Glucose Testing

Early Ultrasound

Ophthalmalogic Screening

Cardiac & Renal Evaluation PATHWAY TO PREGNANCY

INCREASING AWARENESS

CommunityEducatorsStudentGroupsParentsDoctors

GroceryChainsLocal Business

WHATS NEEDED PARTNERS

THANK YOUQUESTIONS?