Gestational diabetes, a significant medical condition during pregnancy, affects about 14% of pregnant women worldwide. A recent series published in The Lancet sheds light on this condition, emphasizing the need for a comprehensive, life-course approach to its management.
The Lancet, following its series on menopause in March, has turned its focus to gestational diabetes, a condition characterized by high blood sugar levels first diagnosed during pregnancy. This series delves into various aspects of gestational diabetes, providing insights into its pathophysiology, screening, management, and prevention, and proposing new models of care to safeguard the health of both mothers and their children.
Rising Concerns and Risk Factors
Gestational diabetes is influenced by several risk factors, including age, family history of diabetes, and high BMI. The prevalence of gestational diabetes is increasing in parallel with a broader rise in non-communicable diseases such as obesity and cardiometabolic disorders among women of childbearing age. The series underscores the urgent need for early detection and modern treatment methodologies, advocating for a lifestyle approach to prevent the onset of gestational diabetes and its associated complications.
Complications and Long-term Effects
The complications of gestational diabetes extend beyond pregnancy, posing serious long-term risks for both mother and child. Up to 31% of type 2 diabetes cases in women who have given birth can be attributed to gestational diabetes. Infants born to mothers with gestational diabetes face higher risks of perinatal morbidity and mortality, as well as long-term issues such as type 2 diabetes, obesity, cardiovascular diseases, and neurodevelopmental disorders. The series includes contributions from experts worldwide, highlighting the need for a comprehensive approach to care.
Barriers to Effective Care
The Lancet editorial identifies two major barriers to adequate care for women with gestational diabetes: resource limitations and the disconnect between secondary maternal care and primary care. This disconnect often results in crucial information about a woman’s pregnancy and its impact on long-term health being overlooked. Additionally, other factors, such as a paternalistic desire to avoid causing worry and the tendency to prioritize the baby’s health over the mother’s postpartum, contribute to inadequate care.
Research Findings and Recommendations
The series includes three key papers:
- The first paper reviews the pathophysiology of glycemic dysregulation in pregnancies affected by gestational diabetes, examining maternal, placental, and fetal factors that influence pregnancy outcomes and future health.
- The second paper discusses the epidemiology, screening, diagnosis, pregnancy complications, and management of gestational diabetes, along with the health and economic implications of various screening and treatment strategies.
- The third paper advocates for a shift from a pregnancy-focused approach to a long-term, life-course perspective in managing gestational diabetes.
Dr. Uma Ram, a senior obstetrician and gynecologist and one of the authors, stresses the importance of considering the intergenerational impact of gestational diabetes. The series calls for a proactive approach to address this issue comprehensively.
Dr. V. Seshiah, a senior diabetologist and advocate for early gestational diabetes screening, recommends universal screening for all pregnant women during the early weeks of the first trimester. His recent paper suggests a testing strategy that has proven effective 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 gestational diabetes.
The Lancet series highlights the critical need for early detection, effective management, and a holistic approach to gestational diabetes to improve health outcomes for mothers and their children, calling for global action to address this pressing health issue.
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