Bertha Ramirez and Rosa Mendoza have a very personal connection to gestational diabetes.
Not only do the Natividad Medical Center employees work with pregnant mothers at the hospital, which has a far higher incidence of the disease than the national average, but they are both pregnant themselves and have firsthand experience with the illness.
Ramirez, a 31-year-old registered nurse and recently certified diabetes educator, said she was all but sure she would have the disease -- a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy.
Family history of disease
Tests had indicated Ramirez had high blood sugar. Her sister had contracted gestational diabetes, her grandmother has been living with Type II diabetes for more than two decades and, as a Latina, she knew her risk factor was particularly high.
But Ramirez was lucky, and subsequent tests revealed she did not have the disease.
Mendoza, a 43-year-old medical social worker who counsels pregnant women with the disease, wasn't so fortunate. Because she hadn't contracted the disease during her first pregnancy, Mendoza didn't expect to get the disease, even though she is Latina and has a family history of diabetes, in addition to her relatively advanced age for pregnancy.
Higher rate in Salinas
When Mendoza was diagnosed with gestational diabetes, which affects about 135,000 pregnant women a year in the United States, she
was referred to Natividad's Diabetes Education Center.
It was there she received counseling on establishing a stable diet and exercise regimen to augment the prescribed medication.
Ramirez, who works part-time offering informal counseling in the education center, said that Mendoza is one of hundreds of pregnant mothers at Natividad who are diagnosed with gestational diabetes each year.
Gestational diabetes occurs in pregnant mothers with high blood sugar, known as glucose, who can't produce enough insulin to convert the glucose to energy. Because extra glucose can cross the placenta but insulin cannot, the fetus begins producing its own insulin to offset the glucose.
As a result, the fetus generates more energy than it needs and the extra energy turns into fat. Such babies can often face health problems, such as damage to their shoulders during birth, a higher risk of respiratory problems and an increased risk of obesity and Type II diabetes.
Ramirez said an estimated 40 percent of all pregnant mothers at the hospital are diagnosed with the disease, exponentially higher than the 4 percent national average. While part of the reason Natividad's average is much higher is because it has a high-risk obstetrics clinic, where pregnant women with the disease are referred, the hospital also has a high percentage of Latina mothers.
The Latino population in general is 1 1/2 times more likely to contract diabetes than whites, and the incidence of the disease among Latinos is expected to double by 2020, she said.
All women with gestational diabetes at Natividad are automatically referred to the Diabetes Education Center, which opened in November 2007 and offers a wide range of counseling and other services for diabetics.
The referral allows the center's staff, led by Ramirez, to counsel the mothers on diet and exercise changes to augment medication in an effort to battle the disease
But, Mendoza said, many mothers tend to believe the medication is enough and they don't have to change their diet or exercise, especially because the disease usually only lasts through the pregnancy.
She estimates only one in three pregnant mothers with gestational diabetes follows the recommended behavioral changes.
Mendoza acknowledged it has been difficult for her to make changes to her own habits, such as cutting back her consumption of high-carb tortillas and her favorite Mexican foods, eating at regular intervals and forcing herself to walk regularly. But she said the alternative is much worse.
"As someone who works with patients, I know there's a higher risk of contracting Type II diabetes and it's scary," she said. "I'm more willing to change my diet and, hopefully, do the right things afterward, too."
Ramirez wants the center to offer support groups for mothers after they deliver to help them keep up positive diet and exercise habits in an effort to reduce the chances they'll contract Type II. She said that after delivery new mothers who had gestational diabetes are simply given a postpartum test and released if the test is negative.
"If they're fine, they're gone," she said, noting that even before they actually contract Type II they're likely damaging their organs.
And they're more likely to raise obese children who are then at higher risk for contracting the disease themselves.
"For the new mommies, I don't know how we're going to keep them coming back."
Ramirez pointed out that the center's fledgling Type II support groups are steadily growing, and she said she hopes to do the same kind of outreach around gestational diabetes. Education, she said, is the key.
"As long as we keep (the information about diabetes) out there and keep people aware, we'll be better off," she said.
Jim Johnson can be reached at 753-6753 or jjohnson@montereyherald.com. To see more of the Monterey County Herald, or to subscribe to the newspaper, go to http://www.montereyherald.com. Copyright (c) 2009, The Monterey County Herald, Calif. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2009, The Monterey County Herald, Calif.