Gestational Diabetes and Pregnancy

We’ve been talking about maternal mortality for so long and employing so many strategies in the fight against mortality, so why is Africa still plagued by high mortality rates? Medicine and technology have evolved to the point where we can provide relatively inexpensive supplies and treatment for pregnant women across Africa, but still pregnant women suffer from an enormous lack of education on health risks during pregnancy.

Gestational diabetes mellitus (GDM) is one such health risk that is widespread yet not very well known. Diabetes is a chronic disease where the affected patient cannot produce or use insulin, resulting in symptoms such as thirst, hunger, weight loss, changes in vision, and fatigue. It reduces blood flow, damages nerves in the feet, and increases the risk of heart disease and stroke. In people with diabetes, heart disease is responsible for 50-80% of deaths (World Health Organization).

Worldwide, GDM affects up to 15% of pregnant women (International Diabetes Foundation). In pregnant women, GDM increases the risk of eclampsia, miscarriage, labor complications, hemorrhage, and stillbirths. These same women are also at higher risk of developing Type 2 diabetes within the next ten years. Their infants are also born with a higher prevalence of obesity and Type 2 diabetes later on. Despite the short-term and long-term health impacts of GDM, it remains an overlooked maternal health issue.

In many low-income African countries such as Ethiopia, diabetes is not a part of the regular screening offered during prenatal care. As a result, many cases of gestational diabetes go unnoticed. Management Sciences for Health (MSH) estimates that as few as two in ten cases are diagnosed. In a study of 1,242 pregnant Ethiopian women, 11% of all screened were positive for GDM. Hidden but high rates of gestational diabetes are credited as the reason maternal mortality rates remain elevated in the face of improving basic health services. In the past 25 years, maternal mortality rates have dropped 45% globally, but few African countries have experienced a similar drop in mortality rates – likely due to hidden diseases and risks such as GDM.

The high prevalence of missed GDM during pregnancy is worrying, but treatment is surprisingly both inexpensive and effective. In the same study mentioned before, 79% of the pregnant women with GDM responded positively to simple interventions such as changes in diet and increased exercise. Pregnant women were recommended to maintain a healthy body weight, eat a healthy diet with decreased sugar, salt, and saturated fat intake, avoid smoking, and receive regular blood sugar tests.

There is no reason why we should not increase screening for GDM when treatment is so basic and inexpensive. Katie Dain, executive director of NCD Alliance, emphasizes interventions on GDM: “Concerted action on gestational diabetes has the potential to accelerate progress toward the MDGs, and simultaneously curb the growing burden of noncommunicable diseases (NCDs). It is a win-win situation.” Thus, screening for and managing GDM is a crucial factor in lowering maternal mortality rates.

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