World Health Day: Don’t Forget Gestational Diabetes

woman-1284353_960_720The 7th of April, marks World Health Day. Since 1950 the day has been used to advocate on selected global health issues. This year the World Health Organisation (WHO) has chosen to dedicate World Health Day to the theme of diabetes. This choice reflects the immense disease burden diabetes now presents and the growing realization that unless urgent action is taken, diabetes will soon become one of the greatest health threats in history.

Approximately 422 million people worldwide are currently estimated to be living with diabetes and this number is predicted to increase dramatically over the next 20 years. An estimated 1.5 million people die of diabetes each year but its impact is much broader since diabetes is a major cause of cardiovascular disease, stroke, amputation and blindness. Diabetes has thus already become a major disease burden not only people living with the disease and their families but also to healthcare systems and society in general. For some countries diabetes is fast becoming a barrier to socioeconomic development. In taking up diabetes as the theme for World Health Day, WHO is acknowledging the magnitude of the challenge diabetes presents.

One type of diabetes that has been consistently overlooked by health policy makers in many countries, however, is gestational diabetes mellitus (GDM). At ICMHD we are taking up this theme in close collaboration with the Dasman Diabetes Institute in Kuwait and we welcome the opportunity on this year’s World Health Day to highlight the need for action on GDM.

Gestational diabetes is typically diagnosed during the second or third trimester of pregnancy and usually goes into remission following delivery. We believe that this may be one of the reasons why GDM has not been given more attention. The lack of attention to GDM to date has meant a paucity of good clinical surveillance and reporting of GDM and as a result the precise magnitude of the problem remains unknown. However, it is thought that globally between two and six percent of pregnancies are affected by GDM and in certain high risk populations prevalence can reach up to 20%[1],[2].

These rates are particularly concerning since GDM can cause serious health problems for both the mother and the child. Gestational diabetes has been associated with obstructed labor and maternal death, as well as serious birth injuries, such as shoulder dystosia, in the baby. Worryingly, GDM can also increase the risk of developing type 2 diabetes (T2DM). Women who have had GDM are seven times more likely to experience T2DM later in life than women with no prior history of GDM and children of these women are also at a higher risk of developing T2DM and obesity later in life[3],[4].

One of the most disturbing trends which has been reported over the past decade is the increasing number of young children diagnosed with type 2 diabetes (T2DM), a condition that until recently was  almost exclusively limited to adults. The reasons for this growing trend in pediatric type 2 diabetes are not clear, but it is important to note that children born of GDM pregnancies are known to be at higher risk of early obesity and of pre-adulthood type 2 diabetes. Enhancing GDM prevention, screening and care has been suggested as a potential tool in the fight against diabetes in the next generation.

For all these reasons, ICMHD calls for more attention to be given to GDM globally and especially in countries where type 2 diabetes is known to be a major problem. ICMHD also stresses the fact that in an era of high migration, our studies have shown that migrants have a high risk of developing type 2 diabetes possibly as a result of high levels of chronic stress, poor food acculturation, dependency on cheep fast foods and relatively rapid changes in lifestyle. They must not be forgotten.

Elizabeth Catherine Maclean and Manuel Carballo

[1] Ferrara A. Increasiing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 2007; 30 Suppl 2-S141-146

[2] Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes: the need for common ground. Lancet 2009; 373:1789-1798

[3] Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestation diabetes: a systematic review and meta-analysis. Lancet 2009; 373:1773-1779

[4] Fraser A, Lawlor DA. Long-term health outcomes in offspring born to women with diabetes in pregnancy. Curr Diab Rep 2014; 14:489

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