Insurer to Support Birth-Defect Program for Diabetics

California Blue Cross, the state’s largest private health insurer, announced Wednesday that it will begin covering the costs of a pioneering preventive health program to reduce the incidence of birth defects in children born to diabetic women.

“The program makes services available that will greatly increase a woman’s chances for a successful delivery of a healthy baby,” said Dr. Brian S. Gould, medical director of Blue Cross of California. “It is not only clinically sound, it is economically rational.”

Diabetic women are five times as likely as non-diabetic women to have children with birth defects. The abnormalities can affect the child’s brain, spinal cord, heart and other organs. Such defects are sometimes fatal, and often require major surgery shortly after birth.

Crucial Early Weeks

Research has shown that most birth defects in children of diabetic women develop during the crucial first seven weeks of pregnancy, when the fetal organs are forming. By the time many diabetic women learn they are pregnant, the damage has already been done.

Doctors aren’t sure exactly why diabetic mothers are at greater risk, but they know that controlling blood sugar levels during pregnancy, particularly the first few weeks, can substantially reduce the risk.

Dr. John L. Kitzmiller, now chief of obstetrics at UC San Francisco, began a pilot program six years ago to help diabetic women closely monitor and control their blood sugar levels. The participants--those who wanted to become pregnant as well as those who were already pregnant--worked with dietitians and social workers, as well as doctors and nurses, to improve their diets and exercise patterns and reduce stress.

Kitzmiller found that women who brought their diabetes under control before they became pregnant cut their risk of having children with birth defects.

Results of Tests

Of 62 women who enrolled in the program before they were pregnant, only one had a child with a birth defect. By contrast, of 80 women who enrolled in the program after they became pregnant, 10--or 12.5%--gave birth to children with birth defects.

“The heart of the story is patient education,” Kitzmiller said at a press conference at the UC San Francisco. “We have to find ways of educating women before they’re pregnant.”

The program Kitzmiller started has grown into the California Diabetes and Pregnancy Program, and is the only state-sponsored program of its kind in the country. Since 1982, nearly 2,000 diabetic women have enrolled in the program, according to Diana Lee, who directs the program for the state Department of Health Services.

Participating hospitals include Sutter Memorial in Sacramento, Long Beach Memorial, Sharp Cabrillo in San Diego, Harbor/UCLA Medical Center, UC San Diego Medical Center, Loma Linda University Medical Center and UC Irvine Medical Center.

Gould said Blue Cross expects to save $1.2 million a year by offering the program to 1.8 million of its 3 million subscribers, with individual cost reimbursement averaging between $500 and $1,000. Infant intensive care can costs as much as $1,500 a day, with the costs for many babies of diabetic mothers reaching $30,000.

Dr. Kenneth W. Kizer, director of the state Department of Health Services, estimated that the state could save at least $14 million a year by enrolling more women in the program.