Karachi: Being overweight or obese, marrying at an advanced age, and having a family history of diabetes are some of the major factors that make women vulnerable to diabetes during pregnancy, a condition carrying serious health risks for both the mother and foetus. Its incidence especially among Asian and African women is increasing, said Stockholm-based medical specialist Dr Carina Ursing, who delivered a lecture on gestational diabetes mellitus (GDM) at the PMA House on Saturday.

GDM is a condition in which women with no previous history of diabetes develop high blood glucose (sugar) levels during pregnancy.

A senior consultant at the Karolinska Institute, Dr Ursing is an expert on GDM and currently engaged in a project in India relevant to her expertise.

Speaking to Dawn on the sidelines of the event which aimed at creating awareness about GDM among medical professionals, Dr Ursing said there had been an unprecedented increase in the incidence of obesity and diabetes all over the world. Unlike the statistics of a few years ago, she added, there were more diabetic patients in developing countries than developed countries.

“Type 2 diabetes has rapidly evolved from a disease of the rich to a disease that now afflicts the poor. Estimates show that diabetes affects at least 285 million worldwide out of which two-thirds occur in developing countries,” she said.

Asia alone accounted for 60pc of the world’s diabetic population and the disease incidence was high in China and India, countries which had undergone rapid economic development, urbanisation and transition in nutritional status, she added.

Studies, she pointed out, had shown that Asian populations developed diabetes at younger ages, at lower degrees of obesity, and at much higher rates given the same amount of weight gain when compared to the Western population.

Answering why diabetes incidence was on the rise among Asians, Dr Ursing said: “People in developing countries are also changing lifestyles by consuming more fast food but keeping the body less physically active. Consequently, they gain weight because of the increased load of carbohydrates. In addition, there could be genetic factors in play because of marrying within families.”

According to her, Asian people generally do not look obese from the outside but they can have more fat around the intestines and other organs (visceral fat) which is more dangerous and a major risk factor for developing insulin resistance.

“Hence, the growing increase in type 2 diabetes mirrors the increased risk to developing gestational diabetes.”

Health implications

Dr Ursing further elaborated that hormones secreted from the placenta during pregnancy not only helped the baby grow but also blocked the action of the mother’s insulin in her body, raising her blood sugar.

“This activity increases as the pregnancy progresses and a modest rise in blood sugar after meals is normal. But, in gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the baby’s growth.

“It usually develops during the last half of the pregnancy — sometimes as early as the 20th week, but generally not until later,” she said.

On its health implications, she said the baby could grow too large (macrosomia) as a result of extra glucose passed on to the baby and subsequent extra production of insulin. The baby as a result was more likely to become wedged in the birth canal and sustain birth injuries, sometimes even requiring a C-section birth.

“A mother’s high blood sugar may increase her risk of early labour and delivering her baby before its due date. The baby can also experience respiratory problems and have a high risk of developing obesity and type 2 diabetes later in life,” she added, stating that untreated GDM could also cause stillbirth.

The mother, on the other hand, had a higher risk of developing high blood pressure as well as preeclampsia, a complication characterised by high blood pressure and signs of damage to another organ systems, often the kidneys.

“Also, a mother with GDM is more likely to develop type 2 diabetes later in life. This risk, however, can be minimised by breastfeeding.”

Such patients were also advised to lose seven per cent of their body weight and exercise 30 minutes, five days a week, she observed.

The risk factors for GDM include marrying or getting pregnant after the age of 25, family history, belonging to an ethnic group with a higher rate of type 2 diabetes, previous diagnosis of GDM or impaired glucose tolerance, previous poor obstetric history, and history of polycystic ovarian syndrome, commonly referred to as PCO whose incidence was also on the rise in women.

To a question, Dr Ursing said GDM was quite common among immigrants with South Asian backgrounds (in Sweden). In many cases, it had to do with sedentary lifestyles along with other factors; eating food with little nutritional value also increased the risk.

The link between obesity and type 2 diabetes, she noted, was established but the relationship between chronic malnutrition and diabetes remained under debate.

“What is clear and important though is to make healthy lifestyle choices such as getting physically active, exercising regularly and eating healthy foods to minimise risk for diabetes as well as GDM,” she concluded.

Published in Dawn September 25th, 2016