Testing for Gestational Diabetes: Window of opportunity to improve maternal & child health & save 2 generations of human life with 1 thoughtful intervention

Dr. Debasis Basu, Specialist in Diabetes & Preventive Cardiology at Apollo Gleneagles Hospital, Kolkata

Worldwide, 425 million people are living with diabetes according to International Diabetes Federation (IDF) Atlas 8th edition. By 2045, this number is expected to increase to 629 million. The awareness & knowledge on diabetes has to be improved significantly to ensure that the health threat posed by diabetes is addressed.

India has one of the highest population of people with diabetes- over 73 million. What measures should be undertaken to stop this mounting challenge?

The need of the hour is to take a special plunge to change the climate of health especially in our motherland “In Dia(bêtes)”. Furthermore, it is time to unveil the customary practice in our cultural setting of keeping our bêtes( which means girls in Hindi, our national language) in a hidden & safe custody to prevent them from the vulnerability of violence, discrimination, gender inequality, sexual abuse and forcible child marriage.

Incidentally, India faces a shameful ignominy when research studies have claimed that Indian women (bêtes) have 11-fold increased risk of developing glucose intolerance in pregnancy when compared to Caucasian women. Sadly, Gestational Diabetes Mellitus (GDM) rate in India is 26.3% (>1 in 4 Indian pregnancies), the highest globally.

Globally, GDM is the leading cause of high blood sugar in pregnancy, affecting approximately 18 million live births. This translates to one in seven live births being affected by GDM.

In India, pregnant women seldom undergo blood sugar testing to determine possibility of GDM. A severe and neglected threat to both maternal and child health, GDM is exhibiting a sharp increase in prevalence in parallel with the increase in number of people diagnosed with diabetes.

GDM not only influences immediate maternal (preeclampsia, stillbirths, macrosomia, and need for caesarean section) and neonatal outcomes (hypoglycemia, respiratory distress), but also increases the risk of future Type 2 diabetes (T2D) in mother as well as the baby.

Almost 60% women in India with GDM progress to T2D within 5 years and >90%, within 10 years, post-delivery. Global data show that children of mothers with uncontrolled diabetes – either pre-existing 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.

Clinical trials now provide evidence for the impact of multiple interventions in preventing the progression to Type 2 diabetes in women with a history of GDM. Both lifestyle modification and pharmacological therapies have been shown to reduce diabetes development by 50% or more. Breastfeeding can also reduce childhood obesity.

Lack of awareness is one of the prime reasons that GDM is given low priority in the public health delivery system in India.

Testing for GDM during pregnancy or before a pregnancy is being planned offers a window of opportunity to reduce preventable maternal morbidity and mortality, and slow down the rising type 2 diabetes pandemic.

Last year the World Diabetes Day (14th November 2017) had the theme: “Women and Diabetes: Our Right to a Healthy Future” and it is here that we fromDIABETES AWARENESS AND YOU(DAY)  proposes to find an avenue to showcase our thought and invite the civic society to join hands in the mission to appraise the strength of such an awareness among the fairer sex.