Maternity hospitals are finding it difficult to cope with the rising number of patients with diabetes, writes Gretchen Friemann
DUBLIN'S MATERNITY hospitals are struggling to cope with a surge in the number of pregnant women with pre-existing and gestational diabetes, and doctors are warning the rise will lead to a greater risk of miscarriages, stillbirths and babies with serious birth defects.
According to Dr Richard Firth, the National Maternity Hospital's consultant endocrinologist, the number of patients attending diabetic clinics at Holles Street, the Rotunda and the Coombe has doubled over the past decade.
Although there has been no recent official study documenting the growing prevalence of the disease among expectant mothers, Firth claims the "dramatic increase" mirrors the expansion of type II diabetes among the general population.
He points out that Ireland's larger, more diverse immigrant population is also a key factor as Asians, Africans and South Americans seem to have a greater genetic predisposition to the disease than Caucasians.
Health Service Executive (HSE) figures show that one person in 20 has type II diabetes, as unhealthy eating habits and sedentary lifestyles fuel an explosion in obesity-related health problems.
And the rapid spread of the disease to younger generations means maternity hospitals are now battling an epidemic that is stretching antenatal services to the limit.
For mothers-to-be with endocrine problems, such as thyroid disorders or type I or II diabetes, this is evident firstly in the increasingly overcrowded weekly diabetic clinics that are run by all three Dublin maternity hospitals.
"Ten years ago there would have been an average of around 30 patients attending these clinics," Firth explains, "but today the figure is normally between 60 and 70. It's a dramatic increase and it means the waiting times can be very long.
"Four to five hours wouldn't be unusual."
Figures maintained by Firth and his colleagues also show that from 2000 to 2006, patient numbers at the clinics rose by 20-30 per cent year on year.
The Rotunda has experienced some of the biggest increases with the number of patients at its weekly diabetic clinic soaring to 80 and above in the past few weeks.
However, the hospital's master, Dr Michael Geary, insists that while the jump in high-risk pregnancies "puts major pressure on the system", the outcome for these patients "tends to be very good" because of the "focused, multidisciplinary care" they receive from the outset.
Geary says staff work "extremely hard" to maintain such high standards, but argues more specialised nurses and dietitians are required to tackle the problem. And although funds for a second diabetic midwife were recently allocated to the Rotunda by the HSE, an appointment the master describes as "extremely helpful", he stresses "we do need more support".
Firth echoes this demand for further funding, pointing out there are few areas in medicine where early intervention can prove so vital.
Untreated, type II or gestational diabetes exposes both mother and baby to serious, potentially life-threatening conditions.
Although these disorders are normally identified before pregnancy or through routine antenatal screening, expectant mothers with type II diabetes are statistically more likely to suffer a poorer perinatal outcome than patients with type I diabetes. In other words, the risk of complications during pregnancy remains higher for women with type II diabetes.
Recent studies in Britain indicate that women with diabetes are seven times more likely to have a stillborn baby than healthy women, while those with type II diabetes are twice as likely to miscarry and five times more likely to have a baby with birth defects compared with women with type I diabetes.
But it's not just the higher incidence of type II diabetes that is worrying health specialists.
Gestational diabetes, which once affected a small proportion of pregnant women, is now also on the increase and doctors are attributing its rise to the spread of obesity.
According to Firth, women with gestational diabetes are often "budding type II diabetics".
"Pregnancy puts additional strain on your body's ability to produce insulin," he says.
"So an expectant mother who is overweight and develops gestational diabetes is likely to also go on and develop type II diabetes."
Gestational diabetes typically presents in the second half of pregnancy and disappears after the baby is born.
For increasing numbers of women, however, the disorder will mean a legacy of type II diabetes later in life - a potentially fatal illness that can produce a barrage of complications, from strokes to decaying limbs.
And as the obesity phenomenon shows little sign of diminishing, doctors are warning that the HSE must do more to tackle the crisis.
According to Geary, the "long-term solution" is to confront "the problem at source" and he suggests that women should be given more information and support about the "importance of maintaining a healthy weight and lifestyle".
Yet he acknowledges that in the short term, and in the absence of further funding, mothers-to-be with endocrine disorders will continue to endure lengthy waiting times at overcrowded antenatal clinics.