Colombo declaration demands increased focus on maternal health to deal with diabetes in South Asia

Shobha Shukla, Citizen News Service - CNS
Delegates at the ‘1st Asia Pacific Congress on Diabetes, Hypertension & Metabolic Syndrome in Pregnancy’, which was jointly hosted in Colombo by the Ministry of Health Sri Lanka, the World Health Organization (Sri Lanka Country Office) and the World Diabetes Foundation, endorsed the Colombo Declaration demanding urgent action to address the link between maternal health and diabetes as a public health priority.

The declaration resolves to address the suboptimal maternal health care and rising incidence of hyperglycaemia in pregnancy (HIP) in order to improve the health of women and future generations of South Asians. The declaration states that focusing on hyperglycaemia in pregnancy provides a unique opportunity to integrate services to improve mother and new born health and address prevention of noncommunicable diseases (NCDs) such as diabetes, hypertension, cardiovascular diseases and stroke. Even though South Asia has remarkably reduced its maternal mortality ratio (MMR), from 550 in 1990 to 190 per 100,000 live births in 2013—a decline of 65%— maternal deaths still continue to be high. With a decline in direct maternal deaths because of targeted interventions, efforts to further reduce maternal mortality will have to be refocused on other indirect causes. Hyperglycaemia is one of the most common medical conditions affecting women during pregnancy — an estimated 25% of live births in South Asia are impacted by it— subjecting them to increased risks of hypertension, obstructed labor, postpartum haemorrhage, infections, still births, premature delivery, newborn deaths due to respiratory problems, hypoglycaemia and birth injuries. The majority of women with HIP have gestational diabetes mellitus (GDM) which develops due to hormonal changes of pregnancy and is confined to the duration of pregnancy.

South Asian women are considered to have the greatest vulnerability for GDM, yet routine testing of all pregnant women for hyperglycaemia is not done. Without preventive care, almost half of the women with GDM develop type 2 diabetes and a significant proportion develop premature cardiovascular disease (CVD) within 10 years of childbirth. Children born to women with GDM are also at very high risk of obesity, early onset type 2 diabetes and CVD, whereby, hyperglycaemia in pregnancy perpetuates the risk of diabetes into the next generation. Diabetes affects over 85 million people in South Asia, and projections show that by 2040 these numbers will exceed 150 million, which is indeed a matter of grave concern. Hyperglycaemia in pregnancy may contribute substantially to this rise. "The rising incidence of hyperglycaemia in pregnancy with its propensity to drive the future burden of diabetes in women and in the next generation of our children is very disturbing and the International Diabetes Federation supports all efforts to create awareness and build capacity to address it,” said Prof S Sadikot, President of the International Diabetes Federation.

Participants pledged to support efforts to

  • Address the link between maternal health and diabetes as a public health priority
  • Increase public awareness about hyperglycaemia in pregnancy and its impact on child health to encourage preconception counselling, antenatal care and post natal followup
  • Accelerate implementation of the FIGO GDM initiative in South Asia
  • Ensure all pregnant women in South Asia attending health facilities are tested for hyperglycaemia, using a single-step procedure 
  • Develop, support and carry out research for the discovery of new tools, treatments  and procedures to improve point of care diagnostics, monitoring and management of HIP and the ability to engage, counsel and track the mother-child pair over the long term, keeping in mind the health care delivery structures of South Asia
  • Promote and celebrate a National GDM Awareness Day as an instrument to bring public attention and raise awareness of the problem

Explaining the need for the Colombo Declaration Prof V Seshiah, Distinguished Professor, The Tamil Nadu Dr MGR Medical University and the Founder Chairman of the Diabetes in Pregnancy Study Group India (DIPSI) said, “We share similar genetics, lifestyles and socio economic development. Our health systems more or less face similar problems of low resources and limited funding. It is therefore necessary that we create common aspirations, and learn from each other. Our hope is that this declaration will inspire all stakeholders to understand the relevance of diabetes to maternal health and to the future health of nations in South Asia.” His Excellency Maithripala Sirisena, President of Sri Lanka and Dr Rajitha Senaratne, Minister of Health & Indigenous Medicine or Sri Lanka addressed the participants at the opening ceremony of the conference on 8th Sept 2016 and highlighted Sri Lanka's efforts to tackle NCDs and improve maternal health.

Sri Lanka's maternal mortality ratio in 2013 was 29 per 100,000 live births—the lowest in the South Asia Region. Focussing attention on GDM is definitely a sustainable and cost effective way of addressing the double disease burden of high maternal and newborn morbidity and mortality and rising rates of obesity, diabetes and CVDs; providing an opportunity for addressing two important components of the sustainable development goal 3 (maternal and newborn health and NCDs) with one comprehensive intervention.

Shobha Shukla, Citizen News Service - CNS
September 9, 2016