Recommendation for early treatment of gestational diabetes

Written By Mark

In a series of research papers, experts revealed the need to introduce urgent strategies to prevent and manage gestational diabetes throughout a woman’s life, including screening and early diagnosis to reduce its complications during pregnancy and childbirth and reduce the risk of developing other health conditions later in life.

The researchers – who work at several universities in Australia, the United States of America, and other countries – will present the results of their series, which were published in The Lancet, at the Scientific Sessions of the American Diabetes Association, which will be held between June 21 and 24 in The city of Orlando, Florida, in the United States of America, and the EurekAlert website wrote about it.

Gestational diabetes is a type of diabetes that is discovered during pregnancy when blood glucose levels are higher than average. It is the most common medical complication of pregnancy in the world, affecting one in every 7 pregnancies.

“Our new series underscores the urgent need for significant change in how gestational diabetes is diagnosed and managed, not just during pregnancy, but throughout the lives of mothers and their babies,” said Professor David Simmons from the University of Western Sydney, Australia.

He adds that gestational diabetes is an increasingly complex condition, and there is no one-size-fits-all approach to managing it. Instead, a patient’s unique risk factors and metabolic profile must be considered to guide her through pregnancy and support her thereafter to achieve the best health outcomes for women and children everywhere.

Increasing rates of gestational diabetes and its complications

As obesity continues to increase worldwide, the prevalence of gestational diabetes has increased 2- to 3-fold across many countries over the past 20 years. Current prevalence rates of gestational diabetes range from more than 7% in North America and the Caribbean to approximately 28% in the Middle East and North Africa.

Between 30% and 70% of women with gestational diabetes have high blood glucose levels from the beginning of pregnancy (20 weeks gestation or earlier, also known as early gestational diabetes). These women have worse pregnancy outcomes (complications) compared to women who do not develop gestational diabetes until later in pregnancy (weeks 24-28).

In studies, where gestational diabetes was not adequately managed (eg not using insulin when required) later in pregnancy, gestational diabetes was associated with an increased risk of caesarean section (16%) and preterm birth (51%).

Women with gestational diabetes have a 10-fold higher risk of developing type 2 diabetes later in life than women who have not had gestational diabetes. They are also more likely to develop high blood pressure, hyperlipidemia, obesity, and fatty liver, which coincide with a doubling of the risk of developing cardiovascular disease during their lifetime.

Early diagnosis for better lifelong health outcomes

Current WHO diagnostic criteria for gestational diabetes recommend screening between weeks 24 and 28 of pregnancy without prior screening.

However, recent evidence suggests that gestational diabetes can be present early in pregnancy. Overall, 30-70% of gestational diabetes can be detected early using an oral glucose tolerance test and includes those who are more likely to be treated with insulin and experience pregnancy complications.

Recent studies have also shown that, among women with early gestational diabetes, identifying and treating the disease before 20 weeks of pregnancy (compared to 24-28 weeks) not only reduces pregnancy complications and postpartum complications, including shortness of breath in newborns. and length of stay in the neonatal intensive care unit, but also improved quality of life mid-pregnancy and increased breastfeeding initiation, which can reduce the likelihood of obesity, type 2 diabetes and other long-term conditions.

“The benefits of early detection of gestational diabetes are clear,” said Dr. Helena Backman from Örebro University, Sweden. “We can keep mothers and babies healthy during pregnancy and hopefully continue on this path throughout life. What we need now is early screening and an approach to managing gestational diabetes that takes into account available resources and the patient’s circumstances.” “.

New strategies to improve the management of gestational diabetes are urgently needed. Recommended strategies developed by the series’ authors include:

  • Early screening for gestational diabetes for those with risk factors, preferably before the 14th week of pregnancy.
  • Promoting health at the population level, especially for women with risk factors, to achieve healthy pregnancies and healthy aging.
  • Annual assessments are intended for women with a history of gestational diabetes to prevent or better manage complications such as type 2 diabetes (particularly in subsequent pregnancies) and cardiovascular disease.
  • More research into gestational diabetes and how to improve the health of women with gestational diabetes and their babies across the life stages.