{"id":12462,"date":"2017-10-11T11:38:24","date_gmt":"2017-10-11T17:38:24","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=12462"},"modified":"2025-03-07T09:39:40","modified_gmt":"2025-03-07T16:39:40","slug":"study-awakens-interest-in-pregnancy-diabetes-links","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/study-awakens-interest-in-pregnancy-diabetes-links\/","title":{"rendered":"Study awakens interest in pregnancy-diabetes links"},"content":{"rendered":"
<\/div>

In the third trimester of her recent pregnancy, Shari Hirsch took on some new responsibilities for herself and her unborn baby.<\/p>\n

She had plenty to do already, caring with husband Eric for their 4-year-old son Jaxson in their Littleton home. But for several days, Hirsch, 28, agreed to take on some extra duties. For example, she stuck to a carefully balanced diet in the form of three daily meals prepared by the Clinical and Translational Research Center kitchen in the Leprino Building at UCHealth University of Colorado Hospital. For three nights, she put a probe on her finger, attached it to a watch-like device, and taped a microphone to her neck.<\/p>\n

Hirsch does not have diabetes, but she also voluntarily wore a continuous glucose monitor, which delivered regular readings of her blood sugar levels. She had a series of blood draws and had her saliva and stool collected.<\/p>\n

If it all sounds like a bit much for a mom-to-be to take on, Hirsch has no complaints, although she did allow that \u201cthe food was incredibly bland.\u201d She handled that with her own seasonings. As for the bedtime device, \u201cIt was a little awkward having something attached to me, but I had no problem sleeping.\u201d<\/p>\n

\"Shari
Shari Hirsch with husband Eric, son Jaxson and newborn daughter Brielle. Hirsch\u0092s participation in CU\u0092s Sleep in Pregnancy study could help to shed light on the possible connections between sleep-disrupted breathing and gestational diabetes.<\/figcaption><\/figure>\n

Diabetes wake-up call<\/h3>\n

Why all the extra effort? Hirsch is part of an ongoing study<\/a> developed by Sarah Farabi, PhD, RN, a post-doctoral fellow with the University of Colorado School of Medicine\u2019s Division of Endocrinology, Diabetes and Metabolism. Farabi is investigating links between a widespread but frequently overlooked problem, sleep-disordered breathing \u2013 think snoring and gasping for air \u2013 and short-term increases in blood sugar levels as well as insulin resistance.<\/p>\n

\u201cSleep affects not just how good we feel but also our metabolism,\u201d Farabi said. \u201cWe\u2019ve recognized how important a mom\u2019s health is to her baby. We know, for example, that smoking during pregnancy has an impact on the baby\u2019s growth. We\u2019re looking in this study at sleep [disruption] as another potential factor.\u201d<\/p>\n

Farabi\u2019s study focuses on women classified as overweight or obese \u2013 those with a body mass index of 30 or greater \u2013 for two important reasons. First, they are more vulnerable to sleep disorders like obstructive sleep apnea, she noted. Second, the Centers for Disease Control and Prevention estimates<\/a> that roughly half of all women in the United States are overweight or obese before they become pregnant. That means Farabi\u2019s study subjects aren\u2019t part of a niche but rather that they reflect a societal reality \u2013 and that they are quite possibly part of an increasingly common cycle linking obesity, sleep apnea, diabetes and other ailments that stem from them.<\/p>\n

Regardless of weight, there are clues to the link between breathing disruptions during sleep and blood sugar spikes, said Teri Hernandez, PhD, RN, an associate professor with the Division of Endocrinology, Diabetes and Metabolism, who is Farabi\u2019s mentor for the study. \u201cFrequent awakenings\u201d from interrupted breathing during sleep cause oxygen levels to drop and trigger a stress response \u2013 the release of adrenaline \u2013 which in turn increases blood glucose, Hernandez said.<\/p>\n

Of course, it\u2019s not clear when a pregnant woman who suffers through nights of fitful, interrupted sleep crosses the line from heightened glucose levels to gestational diabetes, Hernandez said. But there is also no doubt about the ripple effects of those that do. Mothers who develop gestational diabetes are up to 60 percent more likely to suffer later from Type 2 diabetes, Farabi said. The problem may cascade farther: the National Institute of Diabetes and Digestive and Kidney Diseases warns<\/a> that the children of mothers with gestational diabetes could be at increased risk for obesity and Type 2 diabetes.<\/p>\n

Wait until dark<\/h3>\n

It\u2019s very important to diagnose gestational diabetes during the pregnancy because women can manage it with nutrition and medication like insulin, Hernandez noted. However, there are many women who pass the test for gestational diabetes but still have altered patterns of glucose regulation, perhaps because a woman\u2019s sleep problems may go unrecognized or be written off as temporary or to be expected during the often physically uncomfortable months of pregnancy.<\/p>\n

\u201cIn obese women without a diagnosis of gestational diabetes, we will often miss the sleep diagnosis if we don\u2019t have heightened surveillance of their sleep patterns,\u201d Hernandez said.<\/p>\n

On a recent morning, Farabi spread on a table the surveillance tools she uses to study the sleep patterns of pregnant study participants like Shari Hirsch. With them, she aims to shed light on what\u2019s going on in a woman\u2019s body as she lies in the dark.<\/p>\n

The pieces form an FDA-approved device called the WatchPAT from Israel-based Itamar Medical Ltd. A small probe covered by a blue cap fits over the index finger, measuring oxygen levels, heart rate, arterial pressure and other physiologic indicators during sleep. A cord attaches the probe to a device with an LED screen, strapped to the wrist, that records and saves the data. In addition, the patient fixes a small sensor with a microphone at the top of the chest to capture snoring and other sounds, as well as changes in body position.<\/p>\n

The study participants wear the WatchPAT for three nights. It calculates a patient\u2019s Apnea\/Hypopnea Index<\/a> (AHI), as well as her oxygen saturation levels, both key indicators of how severely her sleep was disrupted. Farabi sends women with high AHI scores to their physicians. Participants also get an oral glucose tolerance test, an indicator for insulin resistance, and a series of fasting blood draws.<\/p>\n

These data, along with blood sugar levels recorded by the patient\u2019s continuous glucose monitor \u2013 a sensor placed under the skin that is attached to a transmitter that wirelessly sends measurements to a small display device \u2013 form the body of evidence Farabi needs to solidify the link between sleep disruptions and spiking blood sugar levels. That could, in turn, help clinicians in the future stave off or at least reduce the risk of gestational diabetes in their patients.<\/p>\n

With data from this relatively small pilot study, which is recruiting patients from UCH and other hospitals and clinics along the Front Range, Farabi hopes to secure a long-term National Institutes of Health grant to look at designing interventions for pregnant women with sleep-disrupted breathing and whether breaking the cycle can improve obstetrical outcomes.<\/p>\n

Digging for data<\/h3>\n

The future is in the hands of women like Shari Hirsch, who volunteer to advance the research. After following her carefully controlled and balanced diet \u2013 a study detail included to avoid the possibility of the findings being confounded by food choices \u2013 wearing her WatchPAT and having her tests, Hirsch was happy to find that her blood sugar levels were normal and she did not suffer from sleep apnea. On Aug. 24, she gave birth to a healthy daughter, Brielle, after a C-section.<\/p>\n

\"Sarah
Sarah Farabi, who leads the Sleep in Pregnancy study, shows the WatchPAT sensor study participants wear at bedtime. It is secured at the top of the sternum. A microphone records snoring and other signs of sleep disruption.<\/figcaption><\/figure>\n

But Shari and Brielle had one more commitment to meet for the study. Two weeks after the delivery, they headed to Children\u2019s Hospital Colorado for a test to measure Brielle\u2019s body composition, which can indicate a higher than normal percentage of fat. It\u2019s a concern for children born to overweight mothers; Shari says she weighs about 35 pounds more than she should.<\/p>\n

Brielle spent about two minutes in a small unit called a Pea Pod. The device analyzed Brielle\u2019s body fat through air displacement while recording her length and weight, all the while soothing her with white noise.<\/p>\n

In mid-September, Brielle weighed 7 pounds \u2013 about average, Shari said \u2013 and possessed a healthy appetite. \u201cShe\u2019s a chow hound.\u201d<\/p>\n

Grateful for her and Brielle\u2019s health, Shari said she hopes her participation helps Farabi find ways to protect other women.<\/p>\n

\u201cI was glad to have a chance to be part of the study and that they could use something from me to do research and learn about my baby,\u201d she said. \u201cIt opened my eyes to how important controlling blood sugar is and how it affects the baby.\u201d<\/p>\n

For more information about the study, contact Sarah Farabi at sarah.farabi@ucdenver.edu.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

In the third trimester of her recent pregnancy, Shari Hirsch took on some new responsibilities for herself and her unborn baby. She had plenty to do already, caring with husband Eric for their 4-year-old son Jaxson in their Littleton home. But for several days, Hirsch, 28, agreed to take on some extra duties. For example, […]<\/p>\n","protected":false},"author":2143,"featured_media":12475,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[988,2635,309,57,4202,212],"class_list":["post-12462","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-diabetes-endocrinology-care","tag-diabetes-management","tag-pregnancy","tag-pregnancy-childbirth-newborn-care","tag-sleep-disorders","tag-womens-care"],"acf":[],"yoast_head":"\nStudy awakens interest in pregnancy-diabetes links - 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