14 September 2011

Addressing gestational diabetes in India can prevent other NCDs


Primary health care centre in Chennai, Tamil Nadu in India. The women are queuing to be screened for gestational diabetes 

Karoline Kragelund Nielsen MSc in Public Health is preparing an Industrial PhD at the University of Copenhagen together with the World Diabetes Foundation.

Karoline will be focusing on determinants for gestational diabetes in India as well as barriers and facilitators for ensuring early detection and timely treatment of diabetes in pregnant women. In India she is in collaboration with Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre. We asked Karoline to explain how gestational diabetes is connected to type 2 diabetes.

Why are pregnant women more prone to diabetes and what are the risks associated with pregnancy related diabetes?

Increased insulin resistance is a normal part of pregnancy, usually beginning midway through the pregnancy. In most pregnancies the pancreatic beta-cells will compensate for the insulin resistance and secrete more insulin and thereby maintain a normal balance, but in some cases the increased insulin requirements are not met and the woman develops diabetes.

Pregnancy-related diabetes usually disappears after giving birth; however, it increases the risk of adverse pregnancy outcomes such as maternal and perinatal mortality, obstructed labour, macrosomia and shoulder dystocia. Moreover, both the woman and her infant are at increased risk of developing type 2 diabetes in the future. 

What can be done to prevent diabetes during pregnancies?

Little is known about how we can prevent diabetes during pregnancies, but by detecting pregnant women with diabetes as early as possible and initiate treatment so that their blood sugar levels become normal we can reduce the risk of adverse pregnancy outcomes. In addition, because of their increased risk of developing type 2 diabetes later in life women with pregnancy related diabetes are an ideal group for primary prevention of type 2 diabetes. Many of the women with pregnancy related diabetes are able to bring their blood sugar levels under control with dietary changes perhaps combined with exercise. Only the minority will require insulin to obtain normal blood glucose levels. 

Is pregnancy related diabetes a greater problem in India than in other countries?

Available prevalence rates of pregnancy related diabetes varies a lot between countries. One important reason is that different diagnostic tests and criteria are being employed, making comparisons very difficult. However, studies looking at the ethnicity have found that women of Asian Indian ethnicity are at increased risk of developing diabetes during pregnancy compared to many other ethnic groups. Compared to Caucasians the risk may be as high as 11-fold. Moreover, the prevalence of pregnancy related diabetes is in general said to reflect the prevalence of type 2 diabetes in the given country, and as India is currently experiencing increasing prevalence rates of type 2 diabetes there is much reason to believe that pregnancy related diabetes is increasingly becoming a problem in the country as well. This is supported by studies conducted by our Indian partner, Prof. V. Seshiah, showing that more than 17% of pregnant women in Chennai, Tamil Nadu, had diabetes.

Why do you work with this area - why do you find it important?

Around 80% of people with diabetes live in low and middle income countries. In India, there is more than 50 million people who has diabetes. At the same time many of these countries are still struggling with high maternal mortality and morbidity and poor pregnancy outcomes. Addressing pregnancy related diabetes constitutes a window of opportunity for prevention of both, and this to me is really a chance that we cannot afford to miss. 

Text: Karoline Kragelund Nielsen