A high amount of glucose in the blood, known as gestational diabetes mellitus, is one of the most prevalent pregnancy problems (GDM). GDM was not traditionally seen as a severe worry since it normally resolves itself after delivery, despite the fact that the extra sugar often results in extremely big, difficult-to-deliver infants. “It was not considered a legitimate illness for a long time,” explains clinical epidemiologist Cuilin Zhang of the National University of Singapore. This has changed as a result of many research, including those by Zhang, linking the condition to a long-term risk of chronic diabetes for the mother and childhood obesity for the kid.
The Centers for Disease Control and Prevention performed the first-ever nationwide investigation of changes in gestational diabetes this summer, and the results were concerning. Between 2016 and 2020, the prevalence increased by 30%, affecting nearly 8% of U.S. pregnancies in 2020. According to Elizabeth Gregory, a CDC health expert and co-author of the report: “We know that risk factors, including as obesity and overweight, as well as maternal age, have been growing over time.” As a result of these factors, the worldwide situation has deteriorated. What was unanticipated was the large increase in a single year: GDM increased by 13% in 2020, compared to around 5% in each of the previous four years.
The CDC study did not investigate the causes of the 2020 rise, although the COVID pandemic is a clear factor. “Decreased physical activity, weight increase, and other lifestyle variables are known to influence gestational diabetes,” Gregory says. This view is supported by an Italian study of 1,295 women released earlier this year. It discovered that the prevalence of GDM virtually quadrupled during lockdown periods, going from 3.4 percent prelockdown to 9.3 percent during lockdown. During Italy’s stringent lockdowns, pregnancy weight increase averaged 20.5 pounds, compared to 14.5 pounds before the lockout. A higher body mass index (BMI) was associated with an increased risk.
Other variables that might contribute, according to Zhang, include a bad diet (more snacking and fewer fresh produce), stress, incapacity to exercise, and depression. Zhang and her previous colleagues at the National Institutes of Health discovered that depression is linked to an increased risk of GDM, especially in nonobese women.
The CDC study found that gestational diabetes increased in both nonoverweight and overweight women. Non-Hispanic Asian women had the greatest incidence (14.9 percent), while non-Hispanic Black women had the lowest (6.5 percent). Asians, in general, acquire type 2 diabetes—a condition in which the body fails to utilise insulin effectively—at a lower BMI than persons of other races, and the same seems to be true for gestational diabetes. Zhang recently went to Singapore to lead her university’s new Global Center for Asian Women’s Health, with the goal of learning why and what treatments would be beneficial.
Women who have gestational diabetes have a sevenfold greater risk of getting type 2 diabetes later in life, as well as an increased risk of cardiovascular disease. It is unclear if GDM causes these conditions or whether those who are predisposed to GDM are also predisposed to type 2 diabetes and heart disease. For the newborn, there is a short-term risk of birth damage due to enormous size, as well as a longer-term increased risk of obesity and impaired glucose tolerance.
Zhang and colleagues have shown that early intervention may lower the risk of gestational diabetes. A 2016 Finnish research, for example, discovered that a good diet and exercise routine during pregnancy reduced the risk of GDM by 39% among individuals with a history of the disease or who were obese. Evidence shows that starting such a regimen early in pregnancy, or even before getting pregnant, is the most effective. Unfortunately, most pregnant women are not tested for diabetes until the sixth or seventh month of their pregnancy. Obese women and those with other risk factors should be evaluated much sooner, but this guideline may not be routinely followed by doctors, according to obstetrician-gynecologist Veronica Gillispie-Bell of Ochsner Health Center-Kenner in New Orleans.
For low-income women who do not get normal medical treatment, “pregnancy may be their first chance to find out whether they have diabetes,” adds Gillispie-Bell, who works to lower Louisiana’s high maternal death rate. And the surge in GDM contributes to the current issue in maternal and reproductive health.
