Gestational Diabetes: What needs to be done?
40 million people die each year of non-communicable diseases (NCDs) like diabetes and heart conditions; this is equivalent to 70 per cent of all global deaths. Women, children and adolescents are particularly vulnerable.
Everyone can be exposed to risk factors contributing to NCDs—from unhealthy diets to physical inactivity, exposure to tobacco smoke or harmful use of alcohol. The majority of NCD deaths occur in lower- to middle- income countries. This is mainly due to the lack of screening, diagnosis and access to proper treatment.
Diabetes continues to steal the lives of many, threatening not only the lives of young adults and the elderly, but also unborn babies, with gestational diabetes (GDM) affecting one in seven livebirths. Women who gain excess weight in the first trimester are at higher risk of developing GDM, according to a 2010 study. The correlation was even stronger among women who started their pregnancies overweight.
Untreated GDM is associated with serious short-term complications for both mother and child. When a pregnant woman develops GDM, excess blood sugar passes from her bloodstream through the placenta. Because of this, extra insulin is secreted by the baby’s pancreas to process the sugar. Due to the higher levels of sugar the baby becomes extra-large, which often leads to complications and injuries during birth. There is also a higher risk of preterm birth.
Newborns with excess insulin may have very low blood glucose levels at birth, and are also at higher risk for breathing problems. Moreover, children born with excess insulin have a higher risk of developing obesity and type 2 diabetes in their teens or early adulthood. Approximately 50 percent of women with GDM go on to develop type 2 diabetes within five years of pregnancy.
Healthy eating and exercise is often enough to bring women with GDM in near-normal blood sugar control, positively affecting the health of both mother and child.
Women and children in low- and middle-income countries are three times more likely to suffer from ill-health related to pregnancy and childbirth—one example being GDM. We must inform women of risk factors—so they can make healthier choices—and ensure access to proper diagnosis and treatment for all pregnant women.
Tackling GDM in India, one step at a time
EWEC commitment maker Novo Nordisk is currently working towards achieving this through support to the integration of GDM testing and management into antenatal care services in India.
About 10-14% of all pregnant women in India are estimated to have GDM. However, since blood sugar testing is not a standard practice in large parts of the country, most of them are unaware of their condition.
To prevent GDM—as well as identify and provide care for women with GDM —Novo Nordisk has collaborated with Jhpiego and the State Government of Madhya Pradesh, India for the past two years to field test the national Indian GDM guidelines in the district of Hoshangabad. So far 20,078 women have been tested GDM, of which more than 1,800 have been diagnosed with GDM and managed through lifestyle modifications.
Close to 400 health providers and 1,200 community health workers (ASHAs) have been trained, more precisely: 52 medical officers, 97 staff nurses, 216 Auxiliary Nurse Midwives (ANMs), 30 lab technicians, 9 nutrition counsellors and 1,168 community health workers. GDM testing and management has been initiated in a total of 175 health facilities, and introduced in 975 villages through community outreach services.
The project has developed a series of training aids and operational guidelines to accompany the national treatment guidelines, which going forward will make up a great support for a broader roll-out of GDM testing and management across India. The project has also shed light on the relevance, and shared benefit, of a closer integration of maternal health and NCD prevention.
The work towards ensuring access to diagnosis and treatment of all NCDs in lower- and middle-income countries is critical to achieving quality health and well-being for all, no matter the setting. Thanks to the work of Novo Nordisk and other active organizations, we are another step closer to universally covering everyone’s NCD healthcare needs; however there is still work to be done.