Issue link: https://viewer.e-digitaledition.com/i/71333
and MetroHealth is part of it, to look at the BMI and adiposity and metabolic function of babies who were born of mothers who participated in HAPO." As part of the national Maternal Fetal Medicine Network, MetroHealth's Department of Maternal Fetal Medicine also studied treatment of mild gestational diabetes mellitus (GDM) in pregnant women to determine if treatment improved outcomes for both mothers and babies. The GDM follow-up study is currently in progress. "We're trying to come up with new testing criteria to diagnose GDM," Dr. Catalano explains. "There's going to be an NIH consensus conference of which I will participate in October looking at the IADPSG (International Association of Diabetes in Pregnancy Study Groups) criteria which are based on the HAPO study which may theoretically increase the number of women diagnosed with GDM from 5-8% to 16%." "There's a mixed feeling about perhaps overdiagnosing," adds Dr. Stetzer, who points out that the American Diabetes Association has already endorsed the IADPSG criteria. "But I think it's important to have a higher index of suspicion for patients earlier in pregnancy because of the significant risks of gestational diabetes." As for prevention of GDM, studies over the last five years have shown that while lifestyle intervention — primarily diet and moderate exercise — can decrease the risk of a woman gaining excessive weight during pregnancy, these interventions have not decreased the risk of a woman who is already obese developing gestational diabetes. According to Dr. Catalano, part of this may relate to the fact that the underlying disorder — meaning the woman's decreased insulin sensitivity and beta cell dysfunction — exists prior to pregnancy. And it's very difficult to change that over the course of time once a woman becomes pregnant. So what's the answer? Dr. Catalano and Dr. Stetzer are now in the process of collaborating with physician researchers at Cleveland Clinic to create a program grant to look at lifestyle intervention before pregnancy in women who are overweight Dr. Bradley Stetzer visits a mom who delivered a 9-pound baby. Research has indicated that larger babies are at greater risk for childhood obesity and metabolic dysfunction. and obese to decrease their risk factors during pregnancy. "We think that treatment during pregnancy is good, but treatment before pregnancy — though it's much more difficult to accomplish — is probably better for both the mother and her baby. Because when a women who is overweight isn't pregnant, that's the time to lose weight," says Dr. Catalano. "Trying to do something during pregnancy is, first of all, very diffi- cult and, second, there may be safety issues about losing weight during pregnancy." "A lot of women are having bariatric surgery, and there are issues that need to be addressed in particular for these women — not the least of which is that most physi- cians recommend they don't get pregnant for 12-18 months after surgery until their weight has stabilized," says Dr. Stetzer. "And then there's the nutritional issues that need to be addressed if they've had a bariatric surgery that inhibits absorption." Both physicians emphasize that with more women being diagnosed with gesta- tional diabetes, the primary care physician — whether it be a family practitioner or internist or pediatrician — needs to be aware of the increased risk for the woman's and her child's development of Type 2 diabetes. "There needs to be a continuum of care to prevent it. And we can prevent it," says Dr. Catalano. "There have been studies, like the diabetes prevention trials, which showed that lifestyle intervention for women with former gestational diabetes can decrease the longterm risk of develop- ing Type 2 diabetes." For more information, or to make a referral to the MetroHealth Center for Reproductive Health, call 216-778-5498. ■ PHOTOS COURTESY OF METROHEALTH