Diabetes is a major public health problem in India with an estimated 7 crore adults with diabetes and half as many with prediabetes. Unfortunately, over half remain undiagnosed till late complications set in. The consequences of this for the health system, economic productivity and the individual’s life and family are well documented and well known. Type 2 diabetes, the most common form of diabetes, is primarily preventable among those at risk through proper lifestyle changes.
Transitory form of diabetes
What is less well known is that pregnancy is a diabetogenic stress and as a consequence, some women develop a transitory form of diabetes during pregnancy called gestational diabetes. Women of Indian (South Asian) origin are considered to be at highest risk of gestational diabetes. The International Diabetes Federation (IDF) estimates that up to 25% of pregnancies in South Asia may be affected by hyperglycemia in pregnancy. In India it varies from about 10% in rural areas to about 30% in urban areas. Given that there are approximately 2.7 crore to 3 crore pregnancies each year in India and assuming a modest gestational diabetes rate of 10%, this means that about 27 lakh to 30 lakh women develop it each year.
Gestational diabetes is associated with significantly increased risk of complications during pregnancy such as preeclampsia (fits during pregnancy), prolonged and obstructed labour, need for assisted delivery, postpartum haemorrhage and sepsis, stillbirths, premature delivery, increased risk of neonatal deaths due to respiratory distress, neonatal hypoglycaemia and birth injuries. All these conditions contribute to high maternal and new born morbidity and mortality.
If a woman gets gestational diabetes, it is easier to identify her as being at risk of diabetes and cardiovascular diseases. Almost half the women with gestational diabetes go on to develop Type 2 diabetes within 10 years without preventive care. Children born to women with gestational diabetes are also at very high risk of obesity, Type 2 diabetes, and cardiovascular diseases.
Thus, addressing gestational diabetes has an impact at three levels: it will help lower maternal and new born morbidity and mortality; reduce the risk of future diabetes and cardiovascular diseases in women with gestational diabetes; and possibly break the chain of ‘diabetes begetting diabetes’ by addressing the issue of trans-generational transmission.
Test procedure
However, there is lack of public awareness about gestational diabetes as well as low awareness and capacity within the health systems for testing and providing care. This is despite the availability of national guidelines and diagnosis and management of gestational diabetes by the Ministry of Health and Family Welfare, Government of India. Professor Dr. V. Seshiah, a pioneer in the field of diabetes and pregnancy, along with the Diabetes in Pregnancy Study Group of India suggested a single test procedure which is economical and doable. The World Health Organization, the IDF and the International Federation of Gynaecology and Obstetrics have also approved this test procedure.
A recommendation
Being conceived by healthy parents and born to a mother in good health is the best gift a child can receive as this provides a health advantage. To build a healthy future for the nation, this becomes very important. Several academic associations such as the Diabetes Study Group of India, the Federation of Obstetric and Gynaecological Societies of India and the South Asia Initiative for Diabetes In Pregnancy have recommended that we observe a National Gestational Diabetes Awareness Day on March 10, which is Dr. V. Seshiah’s birthday, in recognition of his service and contribution to the field of diabetes and pregnancy for more than 40 years.
V. Balaji is the founder secretary of Diabetes in Pregnancy Study Group of India and senior consultant Diabetologist
