In Santa Barbara County, we do universal screening for diabetes during pregnancy because our population is high-risk by definition. It’s a Latino population, mostly Mexican-American. The prevalence of diabetes in pregnant women, either gestational diabetes or undiagnosed type 2 diabetes, in this community is between 7% and 12%. Unless we actively screen for diabetes in pregnancy, we would be missing a huge number of women, who would have bad outcomes of pregnancy without proper treatment.
Using a 50-g glucose challenge and a fasting plasma glucose level >140 mg/dL as cutoff for positivity, we identify a large portion of our population for diabetes care. These women attend classes, where they are taught about diet and self-monitoring of blood glucose.
Diabetes testing, education, and care are provided at obstetrics clinics throughout the county. Most of our treatment is dietary manipulation, with referral to the central clinic if needed for initiation of insulin therapy. In most cases, the doctors in the community clinics can initiate insulin when needed using a set protocol. This makes it more convenient for the patients and lessens the burden on the central clinic.
We’ve seen improved outcomes in the mothers and their babies. Our Santa Barbara statistics are incredible. We have reduced the macrosomia rate down to that of the general population, and our cesarean section rate is one of the best in California. In 1985, 33% of our population needed a cesarean section. Now it’s down to about 18% (Figure). The rate is about 20% in communities that don’t have such high-risk patients.