JOIN USAt 72.9 million, India has the largest number of people with diabetes in the world after China, and almost half of these cases are women. Data from the International Diabetes Federation (IDF) reveals that diabetes is the ninth leading cause of death among women globally, causing 2.1 million deaths each year. Furthermore, two out of every five women with diabetes are of reproductive age, accounting for over 60 million women worldwide.
Women who have either Type 1 or Type 2 diabetes prior to getting pregnant have difficulty in conceiving and are at a greater risk of pregnancy complications.
Additionally, one in seven births globally is affected by Gestational Diabetes Mellitus (GDM) - diabetes that develops during pregnancy and accounts for 90% of all cases of diabetes in pregnancy. An estimated 4 million women in India alone have GDM.
Diabetes impacts women in different ways compared to men. As per the IDF, an equal number of men and women have diabetes worldwide. Diabetes uniquely affects women through its impact during pregnancy and the threat it poses to the health of both mother and child. If left undiagnosed or not managed properly, GDM can lead to life-threatening complications for both the mother and the baby.
An increasing number of high-risk pregnancy complications are being caused by GDM, thereby contributing to India's maternal and child mortality. However, compared to other more common causes of maternal and child mortality, diabetes in pregnancy remains a neglected cause.
Mothers with gestational diabetes have a higher likelihood of requiring a Caesarean section, having a miscarriage, or developing high blood pressure. According to the IDF, pregnant women with abnormally high blood glucose are at higher risk of developing GDM in subsequent pregnancies and about half of the women with a history of GDM will develop type 2 diabetes within five to 10 years after delivery.
Recent epidemiological studies in India have shown that diabetes is twice as common in urban India compared to rural India. One of the main challenges in managing the condition is the late/missed cases that could later lead to complications. It is imperative for women to get their blood sugar tested frequently, if they see any probable symptoms or have a family history of diabetes.
In addition to timely diagnosis, there is also a need to explore better and more effective treatment options, which is only possible through clinical research.
Since we are different from the Western population in terms of our genotype as well as lifestyle, the available treatment methods need to be more cohort to be able to manage the current diabetes burden of the country. This can be achieved through more indigenous clinical trials conducted for treating diabetes.
Delivery complications
When women have higher blood sugar during pregnancy, that extra sugar is stored as fat by the baby which can cause it to grow larger than normal in size, a condition known as foetal macrosomia. This can lead to problems during delivery and increase the risk of complications during delivery, bleeding after delivery, injury to the birth canal and uterine rupture.
According to data by the IDF, pregnancies complicated by GDM have a four-fold increased risk of perinatal mortality. Additionally, almost three million babies are stillborn every year, and GDM is a major contributor to that. Studies have revealed that babies born to mothers with GDM also have a higher lifetime risk of obesity and developing type 2 diabetes.
Pregnancy complications and maternal and child deaths due to diabetes primarily occur when the disease goes undiagnosed or is not treated properly. Clinical research is key to improving our understanding of the causes and risk factors of GDM, finding better screening strategies, and developing newer therapies to treat and prevent GDM.
We need to conduct further research to determine what causes certain women with GDM to develop Type 2 Diabetes later in life, how children of women with GDM are at risk, and what we can do to prevent this.
Gestational diabetes as a cause of maternal and child mortality has remained practically invisible until now. Given that India carries a disproportionate burden of both diabetes and maternal and child morality, we must take immediate action to save the lives of our women and children.
(The writer is senior endocrinologist and diabetologist and Director, Centre for Diabetes & Endocrine Care)