Scott G. Winterton, Deseret News
With all of the talk in recent years about the rise in both childhood and adult obesity, one related problem is often overlooked: how excess weight affects pregnant women and their unborn babies.
That topic and others dealing with women's reproductive health are the subject of today's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Dr. Kathryn Walker with Sandy OB/GYN at Alta View Hospital and Lori Eining, assistant nurse manager of the Alta View Hospital Women's Center, will answer questions by phone at 800-925-8177.
Eining said she sees gestational diabetes becoming more and more common as the population in general becomes more overweight.
"We're seeing it maybe once a week, and when that is the case, we have to monitor women much closer" when they come in to deliver their babies, she said.
Nurses will monitor blood sugar, restrict fluids and "make sure they don't have issues with it going too high. Most have to be on insulin drip," Eining said.
When diabetic mothers arrive at the center, nurses start an IV with three different fluids: insulin, normal saline and another drug to help manage the glucose level. Because the babies of diabetic moms are larger than normal — often between 8 and 10 pounds — such women have a higher rate of C-section deliveries, she said.
"When the babies are that big, the moms are often not able to deliver them vaginally, and that complicates the delivery as well," Eining said.
Once the baby is born, nurses have to watch the child carefully because after birth, it is no longer exposed to all of the mother's blood sugar and glucose.
"Their levels have the potential to drop and become a problem," Eining said.
Because the circumstances surrounding gestational diabetes vary widely, "some end up not needing to take insulin during pregnancy, some never have an issue again and others go on to develop Type 2," she said.
Routine prenatal care now includes a glucose tolerance test around 28 weeks to determine whether gestational diabetes is present and to determine how to treat it at that point.
"They're tested whether they're overweight or not," Eining said.
Hypertension can also be a fairly common problem for pregnant women, who can have a seizure if their blood pressure gets high enough. Liver or kidney failure also become a risk factor, as does HELPP syndrome, where the liver is involved, blood platelets drop below normal levels and enzymes increase.
"The only way to fix that problem is delivery," she said, including inducing labor before the baby is full-term. "They end up on a magnesium sulfate drip to keep from having seizures and to help with the blood pressure issue."
HELPP symptoms include headaches, blurred vision, sudden swelling in hands, feet and face, severe heartburn and nausea and vomiting that continues to get worse. Women often have difficulty determining whether there is a problem because some heartburn and swelling are normal in pregnancy, Eining said.
"This can come on very suddenly," Eining said. "Some come in with a severe headache and pain or they'll have a seizure at home."
Besides premature delivery, if the mother has HELPP and experiences a seizure, the baby could be without oxygen for a time. Eining said they see a woman with HELPP syndrome about once a month, and mothers with hypertension about once a week.
Emergency C-sections are another complication, with fetal distress the No. 1 reason for the surgery. Several factors play into such a decision, she said.
"That's why we watch moms very closely," Eining said. "Any time we use Pitocin for (labor) induction, we put the patient on continuous monitoring so if there is an issue we can resolve it."
As health-care costs continue to rise, Eining knows some young mothers or those without insurance may be tempted to try a home delivery to save money, but she has a warning for them: "People think home deliveries are so safe and easy, but if they saw what I see every day, they would never do it."
Today's health hotline
Obstetrics and gynecological issues are the topic of today's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Dr. Kathryn Walker with Sandy OB/GYN at Alta View Hospital and Lori Eining, assistant nurse manager of the Alta View Hospital Women's Center will take phoned-in questions. From the Salt Lake area, call 801-236-6061. Elsewhere, the toll-free number is 800-925-8177, only operational during hotline hours.
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