Gestational diabetes needs attention

This year has been a remarkable year for not just doctors but for all frontline workers in the medical fraternity. Besides fighting the ongoing pandemic, our frontline workers are overburdened with managing and handling patients with non-communicable diseases. A recent WHO survey of 155 countries conducted in May 2020 showed that more than half (53%) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49% for treatment for diabetes and diabetes-related complications; 42% for cancer treatment, and 31% for cardiovascular emergencies.

A significant area which is overlooked and poses threat to maternal and child health is that of gestational diabetes mellitus (GDM), that is diabetes diagnosed during pregnancy. Parallel to an increase in diabetes prevalence, there seems to be an increasing prevalence of gestational DM (GDM) which affects approximately five million women each year. Just like other types of diabetes, it causes high blood sugar that can affect the health of both pregnant women and unborn child.

It is important to understand that the management of diabetes and its complications imposes a huge economic burden on society. Hence, effective strategies are urgently needed to control this epidemic too. The prevalence of gestational diabetes has been reported to range from 3.8% in Kashmir to 6.2% in Mysore, 9.5% in Western India and 17.9% in Tamil Nadu. In more recent studies, prevalence rates are as high as 35% in Punjab and 41% in Lucknow. Our own unpublished data suggests that 30% of expecting mothers attended by consultants have Gestational Diabetes; we are also looking at the possibility of identifying biomarkers to diagnose them earlier. The geographical differences in prevalence have been attributed to differences in age and/or socioeconomic status of pregnant women. It is estimated that about four million women are affected by GDM in India, at any given time point.

GDM not only influences immediate maternal (preeclampsia, stillbirths, macrosomia, and need for cesarean section) and neonatal outcomes (hypoglycemia, respiratory distress, increased risk of congenital heart disease) but also increases the risk of future type two diabetes in mother as well as the baby. Existing literature indicates that prediabetes and diabetes affect approximately six million births in India alone, of which 90% are due to GDM. Children born in GDM pregnancies face an increased risk for obesity and type two diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial.

The diagnosis of GDM may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM could have benefits for sustainable long-term behavioural change. Nurses are educators as they are greatly involved in educating patients to manage their disease. Existing literature has shown positive outcomes through “education” on expecting mother’s condition when nurses are involved and diabetes education helps in improving glycemic controls. We need our nurse educators to be skilled in this teaching-learning process and enable them to listen to the demands and needs of their patients. Better education of the diabetic patient does provide improvement in patient self-care through a better understanding of his illness.

As we stride towards a global shortage of nurses, there is a need for immediate action including increasing nurse recruitment through traditional university routes and expanding new roles and apprenticeship routes. Nurses are advanced caregivers and motivators they play a crucial role in advising the patients about many non-pharmacological modalities which help them to reduce the medications - dietary advice, lifestyle changes etc. Nurses have a crucial role in educating expectant mothers and nursing mothers on this.

Non- communicable diseases (NCDs) are the leading cause of death globally, killing more people each year than all other causes combined but these diseases are largely preventable. These diseases can be effectively treated and controlled. We can turn the tide. But we have a long way to go.

(The writer is neonatologist and founder-chairman at a chain of hospitals)