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Overlooking Gestational Diabetes Means Letting Down The Future Generation

Early action in gestational diabetes is an important public health need.

22/03/2017 11:10 AM IST | Updated 23/03/2017 9:09 AM IST
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Most people are aware that diabetes has reached epidemic proportions worldwide, with India being no exception. Statistics show that India is home to over 68 million patients with diabetes, and it is no surprise that various health conferences and esteemed policymakers have been discussing ways to increase early intervention in the management and control of the disease. However, the relevance of Gestational Diabetes Mellitus (GDM) and the significance of its prevention and management in the fight against diabetes is often undermined.

GDM is detected during the gestational period, i.e., when a woman is expecting a child. It occurs in women of reproductive age, particularly in those who have high blood glucose levels during pregnancy. However, GDM remains confined to the corridors of obstetric wards and labour delivery-rooms, limiting the visibility of the condition with policymakers and healthcare administrators.

Focusing on GDM may also be more effective and efficient in controlling future type 2 diabetes, especially in nations with limited resources.

It is important to realise that GDM has far-reaching consequences for the mother and child, and the impact reaches beyond the pregnancy stage.

Untreated or poorly controlled gestational diabetes can result in negative health implications for the baby. When an expecting mother has gestational diabetes, her pancreas works overtime to produce insulin, but the insulin does not lower the blood glucose levels. This in turn leads to the baby having high blood glucose levels. The baby's pancreas starts producing extra insulin to reduce blood glucose. This can lead to a baby growing undesirably large, and facing potential health problems, including damage to their shoulders during birth. Such newborns are also at a greater risk for developing breathing problems. Babies with excess insulin grow to become children and adults with higher risk for obesity and type 2 diabetes. It also impacts fetal and neonatal outcomes, with an increased risk of spontaneous abortion, preeclampsia, fetal anomalies and fetal demise, as well as a latent increased risk of obesity and type 2 diabetes in the offspring. This health impact has been termed "transgenerational metabolic karma", highlighting the fact that a mother's actions (and intentions) before, during and after pregnancy can influence her unborn baby's health.

Prevention of GDM requires the same precautions and lifestyle changes needed for prevention of obesity and type 2 diabetes. In this case, the focus needs to specifically be directed towards women in the pre-conception stage who are at a higher risk of developing the condition. By encouraging healthy lifestyle changes, such as an improved diet and regular exercise, the risk can be greatly reduced in vulnerable patients, leading to better outcomes and a lower burden of GDM and type 2 diabetes in India.

Changing lifestyle habits in women with GDM can have a positive influence on the larger family and community as a whole, incentivising people to lead healthier lives.

The Dhaka Declaration, an initiative of the South Asian Federation of Endocrine Societies (SAFES) involving Bangladesh, India, Nepal, Pakistan, and Sri Lanka, aims to bring gestational diabetes mellitus (GDM) to the forefront of public health. The initiative strongly advocates universal screening for GDM in all antenatal women and urges stricter targets to assess progress of GDM detection. This is the first step towards early action and prevention of GDM. One of the biggest positives to tacking GDM is the ease of intervention as antenatal women form a relatively small and easily manageable cohort, compared to the entire adult population. GDM, therefore, becomes a favorable target for early action. Focusing on GDM may also be more effective and efficient in controlling future type 2 diabetes, especially in nations with limited resources. Early diagnosis of GDM inevitably has the potential to modify and improve societal attitudes towards health. Changing lifestyle habits in women with GDM can have a positive influence on the larger family and community as a whole, incentivising people to lead healthier lives.

Early prevention, early detection, early control of diabetes, including GDM, is possible only if health systems in India ensure early access to the right interventions. From a GDM- centric perspective, this should include facilities to support contraception, preconception care, antenatal management, psychological support, delivery, and lactation support. It should also encompass programs designed to ensure regular and timely follow up of women with GDM in the postpartum and inter-partum period. This needs seamless transition and collaboration between various specialties such as obstetrics, gynecology, neonatology, radiology, medicine, endocrinology and public health. Such access should be timely and equitable, and should extend to the entire spectrum of facilities required by patients with diabetes. As endorsed strongly by the Berlin Declaration, a multinational call to action for early action in diabetes, there is a need to focus on the growing need to establish and implement local policies for the prevention and management of diabetes including GDM. Early action is the key!

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