IMPACT OF GESTATIONAL DIABETES MELLITUS
As well known, diabetes is a major noncommunicable the disease spread like an epidemic in the world and India is the major country bearing this burden. This disease is especially very important in case of pregnant females as a lot of mortality in both mother and child are associated with it. This gives rise to the necessity for doctors especially family physicians and female practitioners to understand this aspect in detail.
We have designed this course specifically to deal with the patient’s right from the beginning of their pregnancy and post-pregnancy period.
Diabetes is a major public health problem in India with prevalence rates reported to be between 4.6% and 14% in urban areas, and 1.7% and 13.2% in rural areas. India has an estimated 62 million people with Type 2 diabetes mellitus (DM); this number is expected to go up to 79.4 million by 2025. Management of diabetes and its complications imposes a huge economic burden on society; hence effective strategies are urgently needed to control this epidemic.
Not surprisingly, in parallel with the increase in diabetes prevalence, there seems to be an increasing prevalence of gestational DM (GDM), that is, diabetes diagnosed during pregnancy. The prevalence of gestational diabetes has been reported to range from 3.8% in Kashmir, to 6.2% in Mysore, 9.5% in Western India, and 17.9% in Tamil Nadu.
In more recent studies, using different criteria, prevalence rates as high as 35% from Punjab and 41% from Lucknow have been reported. The geographical differences in prevalence have been attributed to differences in age and/or socioeconomic status of pregnant women in these regions.
It is estimated that about 4 million women are affected by GDM in India, at any given time point.
India has a very high prevalence of GDM by global standards. Conversion rates to Type 2 diabetes mellitus are also very high. Healthcare resources are insufficient. There is inadequate awareness among the public. This results in a large population being hesitant to access the healthcare system for diseases with not so “obvious” implications like GDM.
Why should we be concerned about GDM?
GDM not only influences immediate maternal (preeclampsia, stillbirths, macrosomia, and need for cesarean section) and neonatal outcomes (hypoglycemia, respiratory distress) but also increases the risk of future Type 2 diabetes in mother as well as the baby.
A recent meta-analysis showed that women with gestational diabetes have a greatly increased risk of developing Type 2 diabetes (relative risk 7.43, 95% confidence interval 4.79–11.51).
In a recent study from North India, women diagnosed to have GDM were subjected to an oral glucose tolerance test (OGTT) 6 weeks after delivery, as per standard recommendations. A disturbingly large proportion of GDM women had some persistent glucose abnormality after birth.
Impaired fasting glucose (IFG) was seen in 14.5% and impaired glucose tolerance (IGT) in 4.8%, 8% had both IFG and IGT and 6.4% had overt Type 2 diabetes. These figures are a wake-up call to place GDM at the highest priority in our public health system.
Global data show that children of mothers with uncontrolled diabetes – either preexisting or originating during pregnancy – are four to eight times more likely to develop diabetes in later life compared to their siblings born to the same parents in a non-GDM pregnancy.