Coordinating Chronic Condition Care Program

Studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes and chronic heart disease (CDC, 2014). These conditions may put a pregnant woman and her unborn child at higher risk of developing pregnancy complications and can result in maternal or infant mortality.

The Coordinating Chronic Condition Care (4C) Program was initiated in 2016 with March of Dimes grant funding, and is overseen by Eva Peroulas, nursing manager for the Swedish Covenant Hospital Family Birthing Center. The goal of the 4C Program is to coordinate care for women diagnosed with chronic or gestational hypertension or diabetes. Through this project, a multidisciplinary team meets regularly to raise awareness of these conditions among providers, connect providers with best practice in the field and coordinate care for pregnant and postpartum women to improve care navigation and condition management.

Diabetes and Pregnancy

Chronic and gestational diabetes affects many women of childbearing age. Approximately nine percent of women in the United States have diabetes, a condition in which your body has too much sugar (glucose) in the blood. The term preexisting diabetes describes having type 1 or type 2 diabetes prior to becoming pregnant. This is different from gestational diabetes, a condition approximately seven percent of U.S. women develop during pregnancy. 

It’s important for pregnant women to seek treatment for diabetes immediately, as high blood sugar associated with uncontrolled diabetes can be harmful to your baby’s early brain, heart, kidney and lung development. If left unmanaged, both chronic and gestational diabetes can cause serious problems during pregnancy, including:

Preeclampsia: A serious condition in which a pregnant woman begins exhibiting high blood pressure and symptoms that signal her kidneys and liver may not be working properly, such as protein in urine, changes in vision and severe headaches. 

Without treatment, preeclampsia can cause kidney, liver and brain damage and in rare cases lead to life-threatening conditions such as eclampsia and HELLP syndrome. Eclampsia causes seizures and can lead to coma. HELLP syndrome is when you have serious blood and liver problems.

• Premature birth: Birth before 37 weeks of pregnancy. Premature babies are more likely to have health problems at birth and later in life. 

• Neural tube defects (NTDs):
Birth defects of the heart, brain and spine. Birth defects are health conditions present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops or how the body functions. 

• A birthweight of more than nine pounds: Babies of this weight are more likely to get hurt during labor and birth and to be obese or have diabetes later in life. Large babies may need a cesarean birth (c-section), in which the baby is delivered through an incision in the mother’s belly and uterus (womb). 

• Miscarriage and stillbirth: Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.

High Blood Pressure (Hypertension) and Pregnancy
Blood pressure measures the level of pressure in your arteries—blood vessels that carry blood away from your heart to other parts of your body. If the pressure becomes too high, you have high blood pressure (hypertension), which can put extra stress on the heart and kidneys and may lead to heart disease, kidney disease and stroke. 

Some women have high blood pressure before they get pregnant and about eight percent of women develop high blood pressure during pregnancy. High blood pressure usually doesn’t cause any symptoms, which is one reason that it’s very important to receive ongoing prenatal care throughout pregnancy. 

Conditions related to high blood pressure during pregnancy include:

• Preeclampsia: A serious condition in which a pregnant woman begins exhibiting high blood pressure and symptoms that signal her kidneys and liver may not be working properly, such as protein in urine, changes in vision and severe headaches. 

Without treatment, preeclampsia can cause kidney, liver and brain damage and in rare cases lead to life-threatening conditions such as eclampsia and HELLP syndrome. Eclampsia causes seizures and can lead to coma. HELLP syndrome is when you have serious blood and liver problems.

• Premature birth:
Birth before 37 weeks of pregnancy. Even with treatment, a pregnant woman with severe high blood pressure or preeclampsia may need to give birth early to avoid serious health problems for her and her baby. 

• Low birth weight: When a baby is born weighing less than five pounds and eight ounces. High blood pressure can narrow blood vessels in the uterus (womb), preventing your baby from receiving enough oxygen and nutrients and slowing growth. 
 

If you are a provider, please click here for additional resources>>

Resources

Information and resources on gestational diabetes:
March of Dimes>>
Diabetes.org>>

Information and resources on gestational hypertension and preeclampsia:
March of Dimes>>
American Pregnancy>>

Preeclampsia Foundation:
preeclampsia.org

Patient resources for weight management:
rethinkobesity.com>>

Information and resources on high blood pressure:
heart.org>>

La Leche League International: Breastfeeding has been linked with reduced rates of diabetes and obesity
llli.org>>

Fitness and mind/body classes offered at Galter LifeCenter:
Galter Life Center>>


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