Camille Powe was an expert in gestational diabetes long before she and her husband decided to have children. Which is to say, she was already familiar with the oral glucose tolerance test (OGTT), the arduous process of diagnosing gestational diabetes. “Outside of pregnancy, most people are being diagnosed with hemoglobin A1c,” Powe says, describing the relatively simple blood test. An OGTT, in contrast, requires multiple hours of laboratory testing on top of an 8-h fasting period. Recently, while pregnant with her son, in the midst of her OGTT, Powe drafted a new research grant. The proposal: eliminate the OGTT entirely. “Because I was feeling very unwell during that test,” she says, “I think the passion came through in the grant.” The grant was approved, and the study is ongoing.
As a leading voice in endocrinology, Powe hopes to ensure that pregnant and lactating people with diabetes—populations typically left out of clinical trials—receive the same benefits from advances in diabetes care. In essence, this is the goal of her research.
Despite this dedication, Powe’s path to diabetes research was less direct than one might expect. While studying anthropology as an undergrad at Harvard University, she found herself drawn to an evolutionary riddle known as preeclampsia. This condition, which can occur during pregnancy and has serious health implications for the mother, including kidney failure, stroke, and death, can only be cured through delivery. If the fetus is not yet full term, an inherent conflict is created.
How, Powe wondered, can the biological well-being of the pregnant mother run counter to the biological well-being of the child? By what fluke of nature could this tension exist?
“The summer before I went to medical school, my then-boyfriend—now husband—handed me a copy of The New Yorker,” Powe says. “And in that New Yorker was an article about a scientist.” That scientist, Ananth Karumanchi, had discovered the cause of preeclampsia. When Powe, hoping to study preeclampsia, eventually met up with Karumanchi and his close collaborator, Ravi Thadhani, during her time at Harvard Medical School, they had an alternative suggestion. “They said, ‘Camille, we already figured out preeclampsia, but we have another disease for you. It’s called gestational diabetes.’”
One of the underlying difficulties for any pregnancy-related field is the historical lack of studies. This problem has a couple of root causes.
“One reason pregnant and lactating people have been left out of research is sexism, to be honest,” Powe says. “But another reason is paternalism. We want to protect pregnant and lactating people and their babies from experiments and potential risk.” The drug thalidomide, for instance, given to pregnant women in the fifties and sixties to treat nausea, ended up causing birth defects. “People are very scarred from that and want to protect pregnant people from risks,” Powe says. “But the downstream implication of that is that when you systematically exclude populations from your research . . . those populations miss out on some of the best advances.”
Now, as a clinical researcher at Massachusetts General Hospital and Harvard Medical School, Powe wants to close the gap and bring more individualized care to diabetes in pregnancy.
“The way we currently treat diabetes in pregnancy is a one-size-fits-all approach. We treat it as if it has one cause. We follow the exact same protocol whenever anyone is diagnosed with gestational diabetes or has preexisting diabetes,” Powe says. “But anyone who takes care of people with diabetes knows that diabetes is not just one disease. There are many ways to get to hyperglycemia.”
In particular, Powe wants to bring the many advances that have been made in care for type 1 and type 2 diabetes over the last 20 years to pregnant and lactating people.
“We’ve had an explosion in technology, whether that’s continuous glucose monitors (CGMs), whether that’s insulin pumps with automated insulin delivery,” Powe says. “I’m involved in studies that are learning more about, for example with CGMs, the normal levels of glucose in pregnancy, so we can end up using those technologies in pregnant individuals.”
Therapeutics, too, require more studies.
“There could be a lot of opportunity in understanding how those novel medications interact with lactation,” she says. “Determing whether they’re compatible with breastfeeding is a direction we need to go.”
Despite the challenges ahead, Powe is optimistic that including groups that have been left behind will lead to a richer understanding of diabetes for everyone.
“This has to be the future,” she says. “To include our whole population in these research studies so we can all benefit from the incredible advances in science and the types of things that we’re publishing in Diabetes Care.”
