The doctors are in: Two specialties join forces to provide unified care to pregnant women with diabetes

Women with diabetes who become pregnant have among the most difficult pregnancies to manage. But a new joint endocrine and obstetric clinic at MUSC Women’s Health seeks to move those 40 weeks of pregnancy along smoothly to a successful and healthy birth. 

The joint clinic, a passion of Timothy Lyons, M.D., director of the Division of Endocrinology at MUSC Health, began taking patients in November.

Endocrinologist Aundrea Loftley, M.D., said that in the past, obstetricians would manage a patient’s diabetes with consultation from an endocrinologist as necessary. Some hospitals have established endocrine/obstetric clinics in which a patient can see both doctors on the same day, but MUSC Health wants to take the model a step further.

“Our concept is quite novel. Most other joint-clinic models do have the obstetrician, the dietician and the endocrinologist all there, but traditionally, the patient would go from room to room. We are trying something a little different,” she said. “We want to pilot a program where the patient is able to see the obstetrician and endocrinologist simultaneously. That’s going to improve the communication between the specialties. That’s going to give us better health outcomes. And it’s also going to make it easier for our pregnant patients to get the care they need.”

“We want to pilot a program where the patient is able to see the obstetrician and endocrinologist simultaneously. That’s going to improve the communication between the specialties. That’s going to give us better health outcomes. And it’s also going to make it easier for our pregnant patients to get the care they need.”

Dr. Aundrea Loftley

Donna Johnson, M.D., chairwoman of the Department of Obstetrics and Gynecology, said the clinic is starting by taking women with Type 1 diabetes or poorly controlled Type 2 diabetes.

Diabetes increases the risk of preeclampsia, stillbirth and growth problems, Johnson said. Research suggests it can also have lifelong implications for the baby. Once thought of as an older person’s disease, diabetes has increased in recent decades among U.S. adults and adolescents, meaning more women of childbearing age have the condition.

Maternal fetal medicine specialist Barbara Head, M.D., noted that doctors must help to control diabetes in pregnant women much more strictly than in women who are not pregnant, and she credited the endocrinology team with helping patients to achieve the degree of control they need.

Loftley, Head and the two other doctors involved in the clinic – maternal fetal medicine specialist Ryan Cuff, M.D., and endocrinologist Harsha Karanchi, M.D. –appreciate the collaborative nature of the clinic. Cuff said the team approach creates a welcome opportunity for each specialty to learn from the other and to share that knowledge with patients in other settings. More importantly, the doctors agreed, the patients seem to appreciate the collaboration.

“Patients want to know that their providers are talking to one another so when they see them in the room together, they know that’s happening,” Head said.

“Patients’ perception of their care is highly associated with health outcomes,” Loftley added. “We want good health outcomes, so if the patients perceive there is more continuity in their care and better communication, they are going to have better health outcomes. I think it’s good all the way around.”

In fact, the clinic just received a three-year grant from the Duke Endowment to expand the model beyond the Lowcountry region via telemedicine. The group hopes to start the telemedicine clinic in January.

Karanchi and Head also noted they’d eventually like to add preconception counseling.

“We really would like to have an opportunity to meet with those women before they’re pregnant, because that’s going to result in the best pregnancy outcomes for them and their babies,” Head said.