Diabetes in pregnancy can lead to later health problems for women and their children
WOMEN WHO develop diabetes in pregnancy (officially known as gestational diabetes mellitus or GDM) are at a much greater risk of developing type 2 diabetes and obesity in the future, as are their children.
However, the good news is that GDM is easy to diagnose and treatment is available. Early diagnosis and appropriate intervention reduces a woman’s chances of giving birth to a baby who is predisposed to future obesity and diabetes.
Prof Fidelma Dunne (pictured above) of the Atlantic Diabetes in Pregnancy (DIP) network in Galway University Hospital advises women to plan ahead for their pregnancy by trying to achieve a normal weight for their height, resulting in a normal body mass index (BMI) before conceiving.
“Being overweight or obese before and during pregnancy puts women at very high risk of developing GDM. Another important risk factor for GDM is family history of diabetes.
“Older women are more likely to develop the condition – women are now having children when they are older – obesity and age combined places women at an even higher risk of developing GDM.”
The consultant endocrinologist highlights the huge problem with Irish child-bearing women being overweight and obese.
A recent survey of ante-natal women in the west of Ireland revealed that a staggering 60 per cent were overweight or obese, putting them at a greater risk of developing gestational diabetes.
Despite the fact that there was a 100 per cent increase in the diagnosis of gestational diabetes between 2005-10, according to HSE figures, screening for the condition and diagnosis criteria vary considerably from one part of the State to another.
In fact, Diabetes Ireland estimates that up to 65 per cent of GDM cases go undiagnosed and untreated.
“Gestation diabetes is also known as pre-type 2 diabetes so picking it up has major implications not only for the current pregnancy, but for the children and mothers in the future.
“Type 2 diabetes is seven times more common in women with gestational diabetes than in women without the disease,” Prof Dunne explains.
For the majority of women, GDM usually recedes after the child is born. However, when the Atlantic DIP network screened 5,500 women, they found that 18 per cent continued to have pre-diabetes (a condition where blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes) or type 2 diabetes when they were rescreened within one year of delivery.
When this group was rescreened up to five years post-pregnancy, it was shown that 29 per cent of women had problems with pre-diabetes or had established type 2 diabetes.
Prof Dunne says: “If we were to identify these women with proper screening programmes and treat them early with appropriate interventions, we could ensure the pregnancy had a good outcome and the growth of the baby was kept on target, preventing further problems such as obesity and diabetes in the future.
“In 80 per cent of women, the only intervention required is change to their diet and regular and moderate exercise while 20 per cent need insulin. By normalising the mother’s blood sugar during pregnancy, we can eliminate and reduce potential problems for mother and baby.”
She highlights the need for universal screening of pregnant women as opposed to selective screening which can miss a lot of people. The HSE West applied a universal screening programme which found that 12 per cent of pregnancies in the region were affected by gestational diabetes, similar to international figures.
“With ad hoc screening, a woman could be picked up with GDM at 36 weeks which is too late to intervene. We need to diagnose them between week 24 and 28, ideally, and to start corrective action without delay to ensure the best outcome.”
New findings from the Health Research Board-funded Atlantic DIP project are published in the May issue of the Irish Medical Journal supplement. The researchers have shown that breast feeding appears to reduce the chances of the mother going on to develop diabetes in the first year after birth and this is an area they plan to explore further.
Clinical midwife specialist in diabetes at the National Maternity Hospital, Holles Street, Mary Coffey, advises that women who have had GDM should be re-screened regularly (every one to three years) for diabetes and pre-diabetes.
Follow-up screening usually consists of a simple blood test, she says.
Gestational diabetes mellitus, or GDM, is a type of diabetes that occurs in women when they are pregnant. It is the most common medical problem in pregnant women.
The common risk factors for GDM include a higher age, being overweight, not taking regular exercise, family history of diabetes, having had diabetes during a previous pregnancy and having had a large baby (greater than 9lbs 15oz).
The condition is associated with a seven times greater risk for the mother of developing type 2 diabetes after the birth.
In fact, 30-50 per cent of women diagnosed with GDM will develop type 2 diabetes five years after the birth.
GDM is also associated with the development of hypertension, obesity, high cholesterol, and metabolic syndrome.
GDM is associated with premature births, Caesarean deliveries, large babies, three-times higher likelihood of neo-natal ICU admission, hypoglycaemia and other difficulties during birth.
In the long term, babies born to mothers with uncontrolled GDM are associated with a greater BMI at the age of 16, adolescent metabolic syndrome (high blood pressure, high cardiac risk, and abdominal fat leading to insulin resistance) and type 2 diabetes.
GDM: THE FACTS
In 80% of women, the only intervention required is change to their diet and regular and moderate exercise while 20% need insulin
A recent survey of ante-natal women in the west of Ireland revealed that a staggering 60% were overweight or obese, putting them at a greater risk of developing gestational diabetes
■ Gestational diabetes mellitus, or GDM, is a type of diabetes that occurs in women when they are pregnant. It is the most common medical problem in pregnant women.
■ The common risk factors for GDM include a higher age, being overweight, not taking regular exercise, family history of diabetes, having had diabetes during a previous pregnancy and having had a large baby (greater than 9lbs 15oz).
■ The condition is associated with a seven times greater risk for the mother of developing type 2 diabetes after the birth.
■ In fact, 30-50 per cent of women diagnosed with GDM will develop type 2 diabetes five years after the birth.
■ GDM is also associated with the development of hypertension, obesity, high cholesterol, and metabolic syndrome.
■ GDM is associated with premature births, Caesarean deliveries, large babies, three-times higher likelihood of neo-natal ICU admission, hypoglycaemia and other difficulties during birth.
■ In the long term, babies born to mothers with uncontrolled GDM are associated with a greater BMI at the age of 16, adolescent metabolic syndrome (high blood pressure, high cardiac risk, and abdominal fat leading to insulin resistance) and type 2 diabetes.
