Tests Help to Identify Obese Pregnant Women at the Risk of Developing Diabetes

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Highlights:
  • Obese pregnant women are at high risk of developing gestational diabetes (GD).
  • In women, GD increases the risk of spontaneous abortion, prolonged labor and hypertension while in the fetus GD increases risk of stillbirth and congenital anomalies.
  • There are a few factors that will accurately help in predicting the risk of GD facilitating timely intervention.
Identifying obese women who are at increased risk of developing gestational diabetes (GD) early in their pregnancies will help in providing timely and targeted intervention to those women.
Tests Help to Identify Obese Pregnant Women at the Risk of Developing Diabetes
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Maternal Obesity

Maternal obesity poses a threat to both the mother and fetus. In the UK, in 2014 around 7 million were classified as obese. By 2025, obesity is predicted to affect 1 in 5 women worldwide.

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Obesity during pregnancy increases the likelihood of developing infections, gestational diabetes mellitus, preeclampsia (high blood pressure during pregnancy), and risk of cesarean delivery among mothers.

Obesity increases the likelihood of GD by three to five fold. All obese pregnant women are categorized as being at high risk of gestational diabetes, but only around 25% will develop the disorder.

Excess weight gain during pregnancy and after childbirth are future risk factors for obesity in women.

In the growing fetus, it increases the risk of stillbirth and developing congenital anomalies.

Gestational Diabetes

Women with higher levels of blood glucose during pregnancy are said to have gestational diabetes. The prevalence of gestation diabetes is as high as 9.2%, according to a 2014 analysis by Center for Disease Control and Prevention.

During pregnancy, metabolic changes occur within the mother's body to meet the demand of increasing energy requirements of the developing fetus.

During the initial stages of pregnancy, the level of estrogen and placental hormone progesterone increases. These hormones bring about an increase in the size of the pancreatic beta cells and facilitate the production of adequate levels of insulin to lower the blood glucose levels.

There is an increase in peripheral glucose utilization and glycogen storage with a simultaneous decrease in glucose production in the liver. This results in low levels of fasting glucose in the pregnant women.

Gestational diabetes usually begins during 20-24 weeks of pregnancy.

During later stages of pregnancy, increased levels of human chorionic sommatomammotropin (hCS), prolactin, progesterone, cortisol, and estrogen create insulin resistance in the peripheral tissues.

There is also increased production of enzymes such as insulinase by the placenta that causes degradation of insulin.

When insulin decreases, the level of glucose in the blood increases and subsequently results in gestational diabetes.

Impact of GD on Mother
Impact of GD on Fetus
Spontaneous abortion Congenital anomalies
Pregnancy-induced hypertension Jaundice
Frequent urinary tract infection Fetal macrosomia-In this condition, the baby is considerably larger than normal. When the blood sugar levels are high in pregnant women, the extra blood glucose goes through the placenta into the fetus. This results in high blood glucose levels in the growing baby which in turn stimulates the baby's pancreas to increase production of insulin. As a result, the baby receives more energy, which is stored as fat. This results in a large-sized baby with increased muscle mass.
Operative delivery Risk of type 2 diabetes later in life
Prolonged labor Intra-uterine death
Few Factors that Facilitate Early Detection of GD

In the study, funded by the National Institute for Health Research (NIHR), 1303 women were recruited.

Researchers tested many factors and those which accurately predicted gestational diabetes are:
  • Older age of mothers
  • Gestational diabetes during previous pregnancy,
  • High blood pressure
  • Various anthropometric measures such as skin thicknesses, waist and mid-arm circumferences.
  • Blood tests including Hemoglobin A1c or HbA1c- It is a blood test that provides information about the average level of blood sugar over the past three months.
Out of the 1303 women in the study, 337 were affected by gestational diabetes.

Lead author, Dr Sara White from King's College London said: "There is currently no accepted strategy to identify obese women at high risk of gestational diabetes, early in pregnancy. Today, all those classified as obese are considered high risk. With escalating rates of obesity worldwide, a more accurate way of defining risk is necessary in this group."

In this large and comprehensive study, researchers have used an extensive range of different measures to develop prediction tools.

A few clinical factors and biomarkers are already available in clinical practice and they are cost-effective.

"In addition, we have identified a model that does not require blood sampling, which could be developed for low and middle income countries where the prevalence of gestational diabetes and obesity is rapidly increasing."Dr White added.

The researchers are continuing their study into gestational diabetes with the support of Diabetes UK.

Management of Gestational Diabetes

Women diagnosed with GD require intensive antenatal care to control blood glucose and to identify the risk of developing common complications.

Diet - Healthy diet including lots of fruits and vegetables with high fiber content is beneficial. It is advisable to avoid food items with high starch content.

Physical Activity - Mild and regular exercise will increase the utilization of glucose for energy and will help in lowering blood glucose levels.

Insulin Supplement - If the blood glucose level is not controlled by the above measures, insulin injections will be prescribed by doctors.

References
  1. Gestational Diabetes - (http://www.medindia.net/patients/patientinfo/causes-Gestational-diabetes.htm)
  2. What is Gestational Diabetes? - (http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html?referrer=https:www.google.co.in/)
  3. The Impact of Maternal Obesity on Maternal and Fetal Health - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC2621047/)
Source: Medindia
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