A new series published in The Lancet on gestational diabetes takes a deep dive into the subject to come up with suggestions for greater focus on the pregnancy-related affliction, and a shift to a holistic life-course approach in its management.
After a series on menopause in March, The Lancet has launched another series that looks at neglected areas of women’s health. This time it deals with gestational diabetes, which refers to hyperglycaemia or high blood sugar levels first diagnosed during pregnancy. A common medical disorder in pregnancy, it reportedly has a global prevalence of 14%. The series offers insights and evidence into pathophysiology, screening, management, and prevention, besides suggesting new models of care that could protect both women and their children.
Also see | The Lancet Series on gestational diabetes
Age, family history of diabetes, and high BMI are major risk factors, so it comes as no surprise that rates are rising alongside a broader crisis of non-communicable diseases, such as obesity and cardiometabolic disorders, among women of childbearing age. Helmed by an editorial, the series talks of the increased complications associated with gestational diabetes its long term impact on the mother and infant, its rising incidence, the need to detect it earlier than is being done currently, modern treatment methodologies, and the need for a lifestyle approach to prevent the onset of GDM and complications.
Pregnancy complications
Gestational diabetes is associated with an increased risk of pregnancy complications, but it also threatens serious long-term complications for both mother and baby. Up to 31% of type 2 diabetes cases in parous women are attributable to gestational diabetes. Babies born to women with gestational diabetes are at increased risk not only of short-term perinatal morbidity and mortality but also of long-term complications, such as type 2 diabetes, obesity, cardiovascular diseases, and neurodevelopmental disorders. Experts from across the world pitched in as part of the series.
The editorial highlighted, from the research papers in the series, two major barriers to providing appropriate care for these women: first, resources, and second, the isolation of secondary maternal care from primary care, meaning crucial information about a woman’s pregnancy and how it might affect their long-term health is lost. But many other factors probably play into this failure, including a misconceived paternalistic wish to avoid further worrying women, childbearing mostly happening to young and physically well women for whom the long-term risks of non-communicable diseases might seem too distant, and a health-care ecosystem that prioritises the baby’s health after birth over that of the mother.
The first paper reviews the pathophysiology of glycaemic dysregulation in gestational diabetes pregnancies, and the many maternal, placental, and fetal factors from early to late pregnancy that underlie pregnancy outcomes and programming for the future health of mothers, and offspring exposed to gestational diabetes. The second presents the epidemiology of gestational diabetes (early and late), screening and diagnosis, pregnancy complications, medical and obstetric management, and the health and economic considerations of screening, monitoring, and treating gestational diabetes. The third paper focuses on transforming the current pregnancy-focused approach to a long-term, life-course perspective on gestational diabetes.
Uma Ram, senior obstetrician and gynaecologist and one of the authors, says it is important to focus on the intergenerational impact of gestational diabetes. The Lancet series is helpful in the sense that it is where a call for action emerges.
V. Seshiah a senior diabetologist who is quite a GDM evangelist himself, says he has always recommended early testing of all pregnant women. “We have, in a recent paper, recommended universal screening of all pregnant women during the early weeks of the first trimester. Further, we have proposed a testing strategy that has worked well in India: a two hour postprandial blood sugar level of over 110 mg/dl during the eighth to 10th week of pregnancy can predict the risk of GDM.”
(ramya.kannan@thehindu.co.in)
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