Sweet Solution

Unique Group Prenatal Model of Care Takes Aim at Diabetes in Pregnancy

Department of Obstetrics & Gynecology – January 2016

 

Approximately 15 percent of all pregnancies are complicated by some form of diabetes, and this percentage is on the rise. Of patients with diabetes in pregnancy, between 13 and 21 percent have pre-gestational diabetes (type 1 or type 2), with the remainder having gestational diabetes. Of this latter group, 50 percent will develop type 2 diabetes in the next 10 years.

Stacey Ehrenberg, MD, an obstetrician/gynecologist and maternal-fetal medicine specialist at University Hospitals Case Medical Center and Assistant Professor at Case Western Reserve University, is tackling this daunting problem in a unique way. Two years ago, she launched a prenatal support group affectionately dubbed “Sugar Mamas,” designed to provide exceptional care to her high-risk patient population. The group combines treatment with education for effective behavior change.

“Our desire is for these mothers to have access to enhanced education, skills to implement lifestyle modifications and support, not only for the pregnancy, but for the postpartum period and beyond,” says Dr. Ehrenberg. “We know this program can affect generations to come.”

“As high-risk doctors, we see a lot of conditions where we can manage the complications, but we can’t really alter the course of the disease,” she adds. “But with diabetes, there are a lot of things we can do. Numerous studies suggest that outcomes for patients - both moms and babies - are directly related to the mom’s blood sugar control during pregnancy. For women with diabetes who maintain their blood sugar levels in the healthy range during pregnancy, the outcomes are comparable to a woman without diabetes.”

Dr. Ehrenberg developed the model for Sugar Mamas after observing a diabetes management group for non-pregnant women and a prenatal support group for women with low-risk pregnancies. “The next natural step was to combine the two and see if this model would work in patients who have diabetes during pregnancy,” she says.

The group setting offers patients social support, while making the most efficient use of clinicians’ time.

“Clinicians often don’t have the resources and time to see patients on a one-on-one basis and deliver education and social and emotional support in addition to optimal medical care,” Dr. Ehrenberg says. “When we have such limited time face-to-face with patients, we’re missing that educational piece. Knowledge is power, and it motivates patients to do what they need to do.”

With Sugar Mamas, our goal is to create a program where we can provide the highest level of care and education. Not just medical care, but social support as well.”

Each Sugar Mamas group consists of five to eight pregnant women, either with pre-gestational diabetes or gestational diabetes that has been diagnosed within the first trimester. Participants receive prenatal care through group meetings, held every other week for six months, taking them nearly to the end of their pregnancies. During these sessions, Dr. Ehrenberg also provides private individual consultation for each of these women. Group sessions also include education on diabetes, nutrition, breastfeeding, normal aches and pains of pregnancy, contraception, safe sleeping for babies and infant care.

Four groups of women have already completed the Sugar Mamas curriculum. The participation rate exceeds 90 percent, a significant increase from the 60 to 70 percent “show rate” Dr. Ehrenberg sees in the traditional diabetes clinic. Plus, enrollment in the program is growing, thanks to word-of-mouth recommendations from previous participants and referring providers.

Most importantly, the group is achieving its objective. Dr. Ehrenberg notes a growing trend of increased patient compliance with prenatal care and in managing their diabetes.

Based on the early success of Sugar Mamas, she and her team recently launched Sugar Mamas Boot Camp, specifically for patients with gestational diabetes. This group consolidates multiple appointments with a diabetes educator, dietitian and maternal-fetal medicine physician – standard after a diagnosis of gestational diabetes – into a one-time three-hour, one-stop-shop approach. Patients receive diabetes education, nutrition counseling and a one-on-one consultation with a maternal-fetal medicine physician, most often, Dr. Ehrenberg herself. Recently, Dr. Ehrenberg and her team added a stress management component to their program, led by the UH Connor Integrative Health Network. Patients leave the boot camp empowered with information, a plan and resources for managing their health now and in the future.

In addition, patients who “graduate” from Sugar Mamas Boot Camp call in their blood sugar readings to the UH MacDonald Center for Diabetes in Pregnancy’s reporting line every Monday, then get feedback and a plan of action during their weekly phone call. A letter is then sent each week to the patient’s referring provider to keep the entire care team appraised of the most updated diabetes care plan.

Dr. Ehrenberg is studying the effectiveness of group prenatal care programs, like Sugar Mamas, and its relationship to rates of preterm births and other maternal and fetal complications. Already, other medical institutions have approached her to share the Sugar Mama’s group care curriculum.

“We hope to see critical patient populations around the country benefit from similar programs with this effective model of care,” Dr. Ehrenberg says.

For more information on Sugar Mamas or Sugar Mamas Boot Camp at UH MacDonald Women’s Hospital, please contact  Andrea Schalk, RN, at 216-844-8545 for scheduling.