Prize-Winning Diabetes Research

The John J Sciarra Prize Paper Award from FIGO’s prestigious  International Journal of Obstetrics and Gynecology (IJGO) encourages clinical researchers from low- and middle-income countries to promote their work on a global stage.

Recognising outstanding academic achievement in the field, the Prize reflects FIGO and IJGO’s shared commitment to the international OBGYN and scientific community.

Dr Richard Adanu, IJGO editor, explains:

As an international journal and the scientific mouthpiece of FIGO, it’s our responsibility to make sure that colleagues from all FIGO regions, many of whom are from the Global South, get the chance to showcase their research to the rest of the world. Together, we help give a voice to women and children, by bringing to light the challenges they face in ensuring good health.

2018’s winning paper, compares an alternative testing method for the diagnosis of Gestational Diabetes Mellitus (GDM), addressing a critical challenge in women’s health: gestational diabetes, inequality of care, and the long-term link between maternal health and non-communicable diseases (NCDs).

The authors of Randomized cross-over trial comparing the diagnosis of gestational diabetes by oral glucose tolerance test and a designed breakfast glucose profile found that an alternative testing method could be both cheaper and easier to implement than the standard test, a significant opportunity to improve care and prevention for women in low-resource settings.

FIGO spoke with lead author, award recipient and South African Society of Obstetricians and Gynaecologists (SASOG) member Dr Colin Marais. An OBGYN at Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa, he addressed the team's prize-winning research in the context of long-term implications for women’s health in South Africa.

How does your study fit within the global context of ongoing efforts to combat and eliminate NCDs?

Diabetes is a particularly important disease in this regard. Our study will hopefully stimulate change to enable more mothers to receive appropriate treatment during their pregnancies (and thereafter) in a cost-effective and sustainable form.

However, we believe that the problem runs deeper than meets the eye. A global lifestyle adaptation and adjustment will be required before a significant change can be seen – obesity being a major concern. Obstetricians are key facilitators who should help to ensure that every woman has the healthiest pregnancy outcome. Policy makers and governments as a whole will need to rethink the concept of wealth and move away from economic growth as the only global goal.

They should aim to gain more 'healthy citizens,' which will naturally encourage growth in all other areas of society.

With further research and development, what impact could this alternative test have on the diagnosis and timely treatment of GDM, especially in low-resource settings?

Diagnosing GDM and undiagnosed pre-gestational diabetes has significant health implications for the mother and her baby both during and after the pregnancy, but one of the biggest global challenges is the rise in cost of healthcare coupled with a decline in funding. Our alternative test is significantly more cost-effective than a formal Oral Glucose Tolerance Test (OGTT).

This alternative diagnostic test has the potential to expand patient-friendly screening beyond more limited and selective screening protocols. The solution is also pragmatic and potentially implementable in areas far from formal laboratory services and infrastructure. We still hope that continuous lifestyle modification will prevent the progression of GDM to overt diabetes and thus avoid the vicious cycle of mother-child transmissions.

Why is this important, and how can OBGYNs engage with their patients, peers and ministries of health for the optimisation of maternal and fetal outcomes?

Our patients already have pre-existing risks for GDM before they become pregnant and then during pregnancy, diabetes develops or is unmasked. If this is not addressed, it can lead to pregnancy complications, epigenetic modifications, and future health problems for the baby, child, and mother. 

OBGYNs are health advocates, and integration of services is essential.  Additionally, we must lobby the administrators who control budgets and personnel, as we are uniquely placed to understand the life narrative from beginning to end.

FIGO’s journal IJGO is committed to providing a platform for research and perspectives from the Global South. How does this approach strengthen communication and capacity across the global OBGYN community?

Having research published in a highly regarded journal such as the IJGO provides recognition and sends a message to local policy makers. It says that our research efforts are being taken seriously and encourages others to seek pragmatic solutions affecting low-middle-income countries and, as in this case, high-income countries.

What are the most pressing challenges that OBGYNs face in improving women’s health in the southern hemisphere, and how is SASOG mobilising to address these in South Africa?

Hypertensive diseases, obstetric haemorrhage, medical diseases such as diabetes and HIV infection, and preterm birth are amongst our most pressing challenges during pregnancy. However, the rise in obesity within the given socio-economic context has exacerbated already high rates of hypertensive disease, as well as diabetes.

SASOG and academic institutions have worked hard to develop a sense of better care via the “Better Obs” initiatives in private healthcare. These aim to standardise care and, via simple pragmatic solutions, drive down unnecessary cost but improve outcomes for women in South Africa. At the same time there has been an enormous effort to encourage mediation through trained facilitators – a promising move in the right direction.

Annually, more than 70 percent of global deaths are caused by NCDs, a global health crisis compounded by inequality: 80 percent of these deaths occur in low- and middle-income countries. As Dr Priya Soma-Pillay, Honorary Secretary of SASOG, emphasises,

It is about reducing inequity in access to healthcare through novel ideas and affordable technology, so that we can meet the healthcare needs of all women.

FIGO’s Committee on Pregnancy and Non-Communicable Diseases has published guidelines on the diagnosis, management and care of gestational diabetes. Click here for more information.