Gestational diabetes

Improving reproductive health in young women with diabetes

Wednesday, 30 May 2018

Can you describe the aim of this project?

To raise awareness of the benefits of pregnancy planning in women <20 years.

What aspect of this research excites you the most?

Reducing rates of adolescent pregnancy would be a significant achievement as teenage pregnancy, even in the absence of diabetes, is associated with adverse maternal and fetal outcomes with a significant increase in social disadvantage. Knowledge is power but education needs to be structured for the adolescent brain and many of the available tools for pregnancy are structured towards older women with better health literacy than much of our population in Western Sydney. If you have ever been with a young woman who has had to endure a premature delivery for anencephaly, you know that if you can prevent even one occurrence of anencephaly it is worthwhile. Here we have the potential to do even more than that.

What are the risks to mothers and infants with unplanned pregnancies in the context of diabetes?

In addition to the above there is a higher rate of cardiac anomalies, pre-eclampsia, premature delivery with extended hospital stay for the baby and the associated complications for the baby; for the mother there is a risk of accelerated progression of diabetic retinal disease and diabetic nephropathy, the list goes on.

Does your clinical experience with young women suggest they’ll respond well to this education program?

Our experience with managing transition of 15-25 year olds in general is that they are very receptive to change in behaviours provided education is delivered in an age appropriate manner. All members of the team need to be consistent about the messages delivered. Trust is critical to the process of education. Some of the tools we will be using have been developed in the USA, and outcomes were published by the READY pregnancy investigators. We have permission to adapt the written tools used in the READY pregnancy study for Australian conditions and we plan to develop our own education DVD to complement the existing written tools.

There’s a lot of talk about the problems with transition from paediatric to adult care. What are some of the good moments in working with teenagers with diabetes?

Young people are so receptive to change, in fact they are much easier to get to change behaviours than adults in many ways. However, you need to be in it for the long haul. You don’t see the change in the first year and maybe not even in the second or third year but then suddenly the changes start to filter through and then there is no stopping them. I was reminded today about one of our young people who was living in her boyfriend’s car surviving on once a day Novomix when she came to us at age 17. She is now managing her diabetes on an insulin pump, is the proud mother of two healthy boys and planning her third pregnancy.

What’s your Holy Grail – the one thing you’d like to achieve in your research career?

Believe it or not I don’t have a research Holy Grail as such. “Inspiring change” is probably my mantra and that can apply to everything I do.

What is your biggest research hurdle?

Running clinical research projects is always challenging as clinicians who research are generally very busy with day to day clinical practice. However, the lessons learned from clinical research stay with you forever.

Who has inspired you in work or life?

We all need spiritual inspiration. For me, I was changed, once and forever in Christ. The adage “You need to be the change you want to see in the world” is also apt.

Describe your perfect day.

A recent perfect day, surprisingly, involved getting up at 2am to climb Mount Sonder on the Larapinta trail in the NT to see the sun rise over some of the most ancient land in the world. A walk of 14km, then back to camp for a cooked brunch, an afternoon sleep for two hours, and then an afternoon of novel reading, dinner by a campfire, all in the company of my beautiful “other half,” my husband Guy. There was probably a glass of red wine and a cheese platter in there somewhere as well. If my children had been there for dinner as well then it would have been complete

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