Prevalence of diabetes is increasing globally and as per the updated 5th diabetes atlas of the International Diabetes Federation (IDF), more than 371 million people were living with diabetes globally in 2012 out of which nearly 63 million were in India.
The World Diabetes Foundation (WDF) estimates that globally one in ten pregnancies may be associated with diabetes, 90% of which involve gestational diabetes. Gestational diabetes mellitus (GDM) is defined as a transient abnormality of carbohydrate/ glucose intolerance of variable intensity - a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy and it usually disappears after pregnancy. But if left untreated and unrecognized, GDM can result in increased health risks for mother and baby such as high birth weight, birth defects, and other complications. GDM is an overlooked cause of maternal and infant death and serious complications during labour. It may result in obstructed labour, death of the mother and/or baby and birth injury for the infant. Pregnancies complicated by GDM also have a 4-fold increased risk of perinatal mortality. Almost 3 million babies are stillborn every year, and GDM is a major contributor to this. It is estimated that 15% of the total number of caesarean sections may be due to gestational diabetes. It also puts the woman and her child to an increased risk for developing type-2 diabetes later. Approximately 50% with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery.
GDM affects up to 15% of pregnant women worldwide. In India alone, an estimated 4 million women have GDM. These numbers are likely to increase as levels of maternal obesity continue to rise. Freddy Svane agreed that, “Gestational diabetes is one of the major health issues in India and in other countries too. By controlling gestational diabetes we will be able to save two lives—that of the mother and the child, and this is very important. Maternal health issues, including GDM, are very important and I think it all starts by educating people, by educating parents and bringing on the knowledge to the girls and the boys as this is a joint issue and we have to find a common solution. I think that by joining forces of the private sector, the public sector and NGOs, we will have a far better effect in controlling some of these self- inflicted diseases that can be avoided.”
Life style interventions, during and after pregnancy, thus provide important opportunities to improve the lives of mothers and children today and reducing diabetes in future generations. According to gynaecologist Dr Rashmi Jain, “Gestational diabetes is because of insulin resistance developed in the mother during pregnancy. It is a serious problem and may result in still birth, macrosomia and many other problems. Diet plays a very important role here. If the pregnant woman is taking too much of oily food and/or junk food in daily life, gestational diabetes will occur. Culturally the general perception in Indian society is that the woman should be overfed on a rich oily diet during and after pregnancy. This is dangerous for her health. Then again malnutrition is also a driving force for gestational diabetes and 50% of my diabetes patients are from this category. A mother-to-be should neither be overfed nor under fed. She should be eating a normal and balanced healthy diet.”
Dr Jain advises that, “Screening for GDM should be done in the gestational period of 24-28 weeks. If the woman belongs to a high risk group—she is obese or has a history of gestational diabetes/still birth in a previous pregnancy, then screening should be done in early stages, else GDM can be detected only after 5 to 6 months of pregnancy. All pregnant women should be screened for diabetes so that they may deliver healthy babies and also their post pregnancy type 2 diabetes can be controlled.”
Dr Amita Pandey, another leading gynaecologist and Assistant Professor, Department of Obstetrics and Gynaecology, King George’s Medical University also agrees that, “Women who have uncontrolled or undiagnosed diabetes in pregnancy can have several complications like: infertility, recurrent spontaneous abortions, higher risk of congenital malformations in the developing foetus, cardiac malformations, gastro-intestinal malformations etc. Moreover, they have a higher chance of having a macrosomic baby who can have several complications in the early neonatal period like hypoglycemia, hypocalcemia. A large baby can also create problems during childbirth and lead to increased incidence of operative delivery."
Yet, diabetes as a maternal health issue is largely unaddressed in developing countries like India. Gender inequality places a higher burden of social and economic consequences of diabetes on women, while at the same time imposing greater barriers to access to care. Diagnosis of gestational diabetes identifies women as well as their children at very high risk of future diabetes. So identifying and providing care for diabetes during pregnancy are crucial.
Uttar Pradesh is the most populous state in India, and also has one of the highest maternal and infant mortality rates. Amongst many other causes, undiagnosed and untreated GDM is speculated to play a role largely due to the lack of knowledge among health care professionals about its consequences. Keeping this in mind, perhaps, the WDF is supporting a two years long ‘Gestational Diabetes Prevention and Control Project’ in the city of Kanpur, which is being executed by a private hospital of Kanpur in collaboration with the Ministry of Health and Family Welfare, Uttar Pradesh. This project purports to be the first of its kind largest GDM prevalence study done in Uttar Pradesh and aims to screen 55000 pregnant women and improve detection and management of gestational diabetes by building capacity in the public health system through awareness, education and training of trainers. A GDM State Registry will also be established, and a GDM prevalence study will be done based on the screening activities.
Let us hope that this will lead to implementing mandatory gestational diabetes screening in the entire state in the coming years. Diagnosing diabetes in pregnant women and taking measures to prevent and control it is a low-cost intervention both to improve maternal and child health as well as to prevent future diabetes. Providing screening and care to mothers at risk of gestational diabetes is likely to have a multi-generational impact on the beneficiaries as well as on health care systems and budgets and will go long way in improving maternal and child mortality and health.
February 2013
(The author is the Managing Editor of Citizen News Service - CNS. She is a J2J Fellow of National Press Foundation (NPF) USA. She received her editing training in Singapore, has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB, co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia", reports on Hepatitis C and HIV treatment access issues, and MDR-TB roll-out. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)
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