Diabetes, hypertension & metabolic syndrome in pregnancy in spotlight

Shobha Shukla, Citizen News Service - CNS
Over 350 delegates from the South Asia and Asia Pacific Region and other countries are expected to gather in the Sri Lankan capital Colombo between 8th -10th September 2016 to attend the 1st ‘Asia Pacific Congress on Diabetes, Hypertension & Metabolic Syndrome in Pregnancy’, organized by the South Asia Initiative for Diabetes in Pregnancy (SAIDIP) and the DIP Asia-Pacific Symposium on Diabetes, Hypertension, Metabolic Syndrome and Pregnancy (DIPAP).

Diabetes affects over 85 million people in South Asia and is projected to affect over 150 million people by 2040. Also, approximately 45 million are estimated to have pre- diabetes. Not only is diabetes escalating worldwide, the age of onset for diabetes and pre-diabetes is declining, particularly in South Asia, and it now affects many young people in the reproductive age. A majority of people with diabetes, particularly the young and women, are unaware of their condition as they have never been tested. More than 50% of the people with diabetes live in just 8 low and middle-income countries: China, India, Indonesia, Pakistan, Bangladesh, Brazil, Mexico and Nigeria. These countries also account for over half the global live births and 3 of them (India, Pakistan, Bangladesh) fare poorly on the issue of maternal and child health also. Even as South Asia has significantly reduced its maternal mortality ratio (MMR), from 550 (per 100,000 live births) in 1990 to 190 in 2013— a decline of 65%— it still accounts for 24% of global maternal deaths.

Hyperglycaemia in pregnancy (HIP) is one of the most common medical conditions affecting women during pregnancy. An estimated 25% of live births in South Asia are impacted by HIP which significantly increases risk of pregnancy complications like hypertension, obstructed labor, postpartum haemorrhage, infections, still births, premature delivery, newborn deaths due to respiratory problems, hypoglycaemia and birth injuries. “Given the interaction between hyperglycaemia and poor pregnancy outcomes and the role of in utero imprinting— in increasing the risk of diabetes and cardio-metabolic disorders in offspring of mothers with HIP, as well as increasing maternal vulnerability to future diabetes and cardiovascular disorders–- there needs to be a greater global focus on preventing, testing, diagnosing and managing hyperglycaemia in pregnancy” said Professor Moshe Hod, Co President of the Conference.

The majority of women with HIP also have gestational diabetes (GDM), which develops due to hormonal changes of pregnancy and is confined to the duration of pregnancy. GDM is associated with an increased risk of pregnancy and delivery related complications which contribute significantly to maternal and newborn morbidity and mortality. Also, without preventive care, almost 50% of the women with GDM develop type 2 diabetes and significant proportions 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 cardiovascular disease (CVD), thus perpetuating the risk of diabetes into the next generation. Prof V Seshiah, Founder Chairman of the Diabetes in Pregnancy Study Group India (DIPSI) said– "Hyperglycaemia in pregnancy is a major contributor to the rising rates of diabetes, CVD and poor maternal and newborn health all over South Asia." 

Addressing GDM will help lower maternal and newborn morbidity and mortality; reduce the risk of future diabetes and CVD in women with GDM; and break the chain of intergenerational transmission of diabetes and metabolic problems. Women in the developing world, especially from South Asia, are particularly vulnerable to GDM and considered at high risk. Yet these countries do not routinely test all pregnant women for diabetes. Of the relatively few women who are tested and detected, only a small proportion receive treatment, and even fewer receive the critical postpartum follow up and care they need. Given the link between hyperglycaemia in pregnancy, poor pregnancy outcome, and future risk of diabetes in both mother and offspring, a focus on prevention, screening, early diagnosis and managing hyperglycaemia in pregnancy is needed globally. The International Federation of Gynaecology and Obstetrics (FIGO) recommends that all pregnant women should be tested for hyperglycaemia using a simple one-step procedure. "Focusing attention on GDM is 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 cardiovascular diseases. It also provides the opportunity of addressing two important components of the sustainable development goal 3 (maternal and newborn health and NCDs) with one comprehensive intervention" said Dr. Anil Kapur, Chairman of the World Diabetes Foundation.

Shobha Shukla, Citizen News Service - CNS 
September 5, 2016