Tackling gestational diabetes in the womb

Published - May 19, 2013 02:26 am IST - CHENNAI:

When they give us those alarming figures about diabetes in the country, they are not even counting the three million women who are pregnant and diabetic every year.

It is estimated that about 10 per cent of women who get pregnant every year develop diabetes during their gestation period, usually in the last trimester. Even with 10 per cent, the numbers in this country are damning: it works out to about three million women every year, counting the total number of annual deliveries at 27 million.

Of these three million women, in 5-10 years after pregnancy, 30 per cent go on to develop Type 2 Diabetes, according to Hema Divakar, president, Federation of Obstetricians and Gynaecological Societies of India (FOGSI). Samar Banerjee, diabetologist, Vivekananda Institute of Medical Science, Kolkata, adds that in women followed up for 20 years, it was clear that up to 70 per cent of them who had gestational diabetes mellitus (GDM) went on to develop diabetes.

And there are clear factors that facilitate this: enormous weight gain after pregnancy, following a sedentary lifestyle and not eating healthy, he adds. “When women are pregnant, they listen to everything the doctor says, but once the baby is born, they don’t even return for follow-up checks,” Dr. Divakar adds.

In a sense, we are entering an environment where the family is most willing to do something about the mother’s condition during her pregnancy. This is an opportunity to enable the whole family alter its lifestyle,” said Anil Kapur, board member, World Diabetes Foundation.

No wonder then that the federation has been agitated enough to reach out to these people, by organising training programmes on gestational diabetes for members. Dr. Divakar, explains, “This is an effort to address the tsunami of diabetes in this country. The woman who develops diabetes in pregnancy has an increased risk of developing Type 2 Diabetes later in life. In addition, there is a high risk for the baby born to such mothers too.”

While that sounds scary, it is possible, with simple techniques, to ensure that both the mother and foetus remain diabetes free. “Focus on the foetus for the future,” says V.Seshaiah, chairman, Diabetes in Pregnancy Study Group India (DIPSI), the agency that is partnering FOGSI in the venture.

“The intra-uterine environment is very precious, how a baby shapes out is decided here. It is important to not let the baby in the womb know that the mother has diabetes. It is possible, even with following a recommended meal plan, he says.

Dr. Divakar indicates the accepted protocol to test pregnant women: One dose, 75mg of glucose solution is used to check the post-prandial sugar levels. Anything in excess of 120 means a need to investigate further. “If we assume that a doctor can do this test just once, then let it be done at 20 weeks.

However, with the more awareness we manage to get out, it will be ideal to test at 12 weeks of pregnancy.” FOGSI and DIPSI together will train 100 master trainers to then train 1000 others in 25 regions across the country.

“We hope to map and tap every single case of GDM in the country. Intervention with follow-up over several years is the only way to prevent mothers moving into diabetes,” Dr. Divakar says.

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