Diabetes: Breaking The Family Cycle
Over 199 million women are living with diabetes, and by 2040 it will be 313 million. Hyperglycemia – dangerously high blood sugar – is one of the most common medical conditions seen during pregnancy, with an estimated one in seven cases brought on by gestation.
Alongside the cause is the effect: risk for the mother, the baby, and the self-perpetuating cycle of rising rates for future generations.
This World Diabetes Day, FIGO reaffirms our call for greater attention to the link between maternal health and non-communicable diseases in the Sustainable Developmental Goals (SDG) agenda: in particular, to gestational hyperglycemia and its propensity to fuel the global diabetes, obesity and cardiovascular disease pandemic.
This year’s theme is ‘Diabetes and the Family’. We spoke to Dr Anil Kapur, Chair of the Board of the World Diabetes Foundation and member of FIGO's Pregnancy and Non-Communicable Diseases Committee, about the science, the impact - and why he is optimistic that pregnancy is a powerful moment for taking on the NDC pandemic.
Part 1 below:
What does it mean for the family when a woman suffers with diabetes in pregnancy?
Hyperglycemia (high blood sugar) during pregnancy typically has two causes: a pre-existing diagnosis of diabetes, or Gestational Diabetes Mellitus (GDM) detected in routine testing during pregnancy. GDM is a transitory form of diabetes which reverts to normal after delivery - but in both cases, the implications for the mother, her unborn baby and the family are quite worrisome.
What are the immediate risks for the mother and baby?
Women with GDM are more prone to pregnancy induced hypertension (PIH), which can lead to preeclampsia. This is a major cause of maternal deaths and preterm deliveries. The babies are larger, which increases the risk of obstructed labour or shoulder dystocia (when the baby is stuck in the birth canal). Obstructed or prolonged labour will in turn increase the risk of postpartum hemorrhage (PPH) and infections, two other major causes of maternal morbidity.
There is also a high risk of abortion, still birth and preterm birth, while the babies born are at great risk of respiratory distress and hypoglycemia (low blood sugar). This all requires intensive care for survival, and expert supervision of the delivery or cesarean delivery.
Women with GDM are themselves at a very high risk of developing diabetes and cardiovascular disease within a few years if preventive lifestyle actions are not taken. Within five years, they have a five times higher risk of developing Type 2 diabetes; after five years the risk increases to nine.
Ultimately, nearly two-thirds of women with GDM go on to develop Type 2 diabetes within 10 years, without preventive care. Women with GDM are also at very high risk of early cardiovascular disease – so much so, that we say women who develop premenopausal cardiovascular disease very likely had GDM, whether or not it was diagnosed.
What is the family legacy?
This is the most crucial part: children born to women with GDM are at very high risk of obesity, Type 2 diabetes and cardiovascular disease, due to changes that occur during development in the mother's womb. We call this ‘intrauterine programming,’ whereby the mother’s nutritional, physical and mental health has profound effect on the future health of their offspring – wisdom known for ages but now with irrefutable scientific evidence.
Not only is the child’s risk higher, but the onset of these conditions occurs earlier - during early adult life and sometimes even in childhood. For the girl child born to a mother with GDM, she will in turn most likely develop GDM early on when she becomes pregnant. Thus the cycle repeats in subsequent generations with ever increasing risk accumulation.