gestational diabetes A window of opportunity to improve maternal and child health and slow down the diabetes pandemic CHAYA NAYAK India Chaya is mother to three young children and has type 2 diabetes
Diabetes is a growing global health emergency impacting the lives of more and more people every day By 2040, this will rise to 415 MILLION adults have diabetes. 642 1 MILLION. 1 This rise in the number of people with diabetes is associated with ageing populations, economic development, increasing urbanisation, less healthy diets and reduced physical activity. 2 A person with diabetes has high blood sugar (hyperglycaemia) either because the body is not producing enough insulin or because the body does not respond properly to insulin. 1 High blood sugar is one of the most common medical conditions associated with pregnancy 1 20.9 MILLION (16.2%) live births were affected by some form of high blood sugar in pregnancy in 2015. 1 85% OF CASES were due to gestational diabetes (GDM), a temporary type of diabetes that in most cases disappears after birth. 1 GDM appears during pregnancy and can lead to serious health risks for both mother and child. 1 It is also associated with an increased risk of both mother and child developing type 2 diabetes later in life. 3,4
GDM is the leading cause of high blood sugar in pregnancy, affecting approximately 18 million live births 1 ONE IN SEVEN live births is affected by GDM 1 3
Untreated GDM is associated with serious short-term complications for both mother and child 5,6 LARGE BABIES (MACROSOMIA) Macrosomia is common in cases where GDM is not recognised and treated. As many as 15 45% of newborns to mothers with GDM are affected. 7 PRE-ECLAMPSIA Women with GDM are at increased risk of pre-eclampsia 10 13 a leading cause of maternal deaths due to childbirth and stillbirths worldwide. 14,15 STILLBIRTHS AND NEWBORN DEATHS Pregnancies complicated by GDM also have a fourfold increased risk of stillbirth and death in the first week of life. 8 Almost 3 million babies are stillborn every year, 9 with GDM being a major contributor. PRE-TERM BIRTHS High blood sugar in pregnancy increases the risk of early labour and delivery. 16 OTHER COMPLICATIONS Children born to women with GDM are at increased risk of respiratory distress, hypoglycaemia, jaundice and other complications. 16 The risk of complications increases as maternal blood glucose levels rise. 6 4
GDM can have a long-term health impact on both mother and child 3,16,17 WOMEN with GDM are at increased risk of developing diabetes and other noncommunicable diseases (NCDs), such as cardiovascular disease, later in life. 16 Approximately OF WITH WOMEN GDM go on to develop type 2 diabetes within five years of pregnancy. 17 CHILDREN born to women with GDM are at increased risk of developing diabetes, obesity, hypertension and metabolic syndrome. 16 Children born to women with GDM are up to MORE LIKELY to develop type 2 diabetes 3 and obesity in their teens or early adulthood. 16 50% 8 TIMES 5
Integrating GDM testing and management into maternal health interventions can reduce both the short- and longterm impacts of diabetes Lifestyle changes are often sufficient to achieve near-normal blood sugar control levels. 18 HEALTHY EATING EXERCISE MEDICATION (if necessary) A number of professional and patient organisations advocate for universal testing of pregnant women to detect GDM: International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 19 International Federation of Gynecology and Obstetrics (FIGO) 16 International Diabetes Federation (IDF) 20 6
Testing for GDM during pregnancy offers a window of opportunity to reduce preventable maternal morbidity and mortality, and slow down the rising type 2 diabetes pandemic 21 REFERENCES 1. International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2015. 2. World Health Organization. Global Report on Diabetes. World Health Organization, 2016. 3. Clausen TD, Mathiesen ER, Hansen T, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes the role of intrauterine hyperglycemia. Diabetes care. 2008;31(2):340 346. 4. Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet. 2009;373(9677):1773-1779. 5. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. New England Journal of Medicine. 2005;352(24):2477 2486. 6. The HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine. 2008;358(19):1991 2002. 7. Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Annals of nutrition & metabolism. 2015;66 Suppl 2:14 20. 8. Kim C. Gestational diabetes: risks, management, and treatment options. International Journal of Womens Health. 2010;2:339-351. 9. Cousens S, Blencowe H, Stanton C, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. The Lancet. 2011;377(9774):1319 1330. 10. Bryson CL, Ioannou GN, Rulyak SJ, Critchlow C. Association between gestational diabetes and pregnancy-induced hypertension. American Journal of Epidemiology. 2003;158(12):1148 1153. 11. Innes KE, Wimsatt JH, McDuffie R. Relative glucose tolerance and subsequent development of hypertension in pregnancy. Obstetrics & Gynecology. 2001;97(6):905 910. 12. Yogev Y, Langer O, Brustman L, Rosenn B. Pre-eclampsia and gestational diabetes mellitus: does a correlation exist early in pregnancy? The Journal of Maternal-Fetal & Neonatal Medicine. 2004;15(1):39 43. 13. Yogev Y, Xenakis EM, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. American journal of obstetrics and gynecology. 2004;191(5):1655 1660. 14. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. The Lancet. 2006;367(9516):1066 1074. 15. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. The Lancet. 2005;365(9461):785 799. 16. Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. International Journal of Gynecology and Obstetrics. 2015;131:S173. 17. Kim C, Newton KM, Knopp RH. Gestational Diabetes and the Incidence of Type 2 Diabetes: A Systematic Review, Diabetes Care 25, 2002. 18. Cheung NW. The management of gestational diabetes. Vascular health and risk management. 2009;5:153. 19. International Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes care. 2010;33(3):676 682. 20. International Diabetes Federation. Global Guideline: Pregnancy and diabetes. International Diabetes Federation, 2009. 21. Kapur A. Links between maternal health and NCDs. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015;29(1):32 42. The Apis bull logo and Changing Diabetes are registered trademarks of Novo Nordisk A/S. 2016 Novo Nordisk A/S, Novo Allé, DK-2880, Bagsværd, Denmark, ZINC#HQMMA/CD/0416/0228a. Approval date: April 2016 7
DIANA TORRECILLA Colombia Diana had gestational diabetes during her pregnancy Our contribution As a leader in diabetes care, we work to prevent, treat and ultimately cure diabetes. In 2009, we launched the Changing Diabetes in Pregnancy programme to create awareness of the links between diabetes and pregnancy. Together with diabetes and maternal health communities, and through collaboration with professional societies, we are working to raise awareness of the challenges and opportunities in addressing GDM and to improve access to diagnosis and care. See more at novonordisk.com/cdip I was really surprised to find out my condition could be controlled by physical activity and the right food, says Diana Torrecilla, who had GDM during her last pregnancy. She was part of the Novo Nordisksupported Vida Nueva project in Colombia. 8