For Mother's Day, Fighting a Disease in Mothers: Gestational Diabetes
You've heard about type 1 and type 2 diabetes, of course. But how much do you know about gestational diabetes? Unless you're one of the 4 to 8 percent of all childbearing women who develop it, you may know relatively little. And even women who have gestational diabetes aren't getting all the information they need to stay healthy. That's why ADA is supporting proposed legislation that aims to secure funding for education, screening, and research in the area of gestational diabetes.
Gestational diabetes is a form of diabetes that is first recognized in women during pregnancy. It occurs when the insulin-producing beta cells of the pancreas can't keep up with the increasing insulin demands of late pregnancy. Why this happens is not known, but many of the risk factors for developing gestational diabetes are the same as those for developing type 2, such as being overweight and having a family history of diabetes in close relatives. And while it usually goes away after childbirth, about 40 percent of women with gestational diabetes will go on to develop type 2 in the 5 to 10 years after delivery.
The Gestational Diabetes Act, also known as GeDi, proposes tracking mothers who have had gestational diabetes and supporting prevention programs that would keep these women from developing diabetes later in life. Introduced in 2007 by Senators Hillary Clinton (D-NY) and Susan M. Collins (R-ME), and Congressmen Eliot Engel (D-NY) and Vito Fossella (R-NY), the legislation would create a Research Advisory Committee to be headed by the Centers for Disease Control and Prevention (CDC). The committee would fund research projects and improve data collection pertaining to gestational diabetes.
According to Michelle D. Owens, PhD, co-team leader of the National Public Health Initiative on Diabetes and Women's Health at the CDC, current diabetes research does not focus enough on gestational diabetes—or even on how diabetes applies to women generally. "Most of the research will only show the data according to how it impacts men's health, and that data is extrapolated to suggest how it affects women's health," she says. "We need data about how diabetes and diabetes-related complications may impact women differently."
To date, that information has not been consistently collected, says Owens. "We'll find that medical records may not document that women had gestational diabetes," she says. "This suggests we need to improve our data collection systems and have better ways to follow up with those women." One thing that researchers have learned: The same minority groups that are at higher risk for type 2 diabetes, including Native American, Asian American, African American, Hispanic/Latina, and Alaska Native women, are also at a much greater risk for developing gestational diabetes.
And gestational diabetes isn't only a danger for mothers. Poorly controlled diabetes later in pregnancy—whether type 1, type 2, or gestational—can cause the baby to grow too large. This increases the need for Cesarean section and the risk of injury to the baby at birth. The threat continues after birth, as the child of a mom with gestational diabetes is more likely to develop type 2 later on if the child is overweight or obese during childhood or adolescence.
The grant programs proposed in the GeDi Act could be used to bolster community programs, support states in their prevention efforts, and train and educate health care providers about gestational diabetes and the significance of follow-up. "These women may not be going back for follow-up screening after they have the baby, so it's unclear if they're following recommendations to exercise, lose weight, and maintain a healthy diet," Owens says. According to a study published in the American Journal of Public Health in Sept. 2006, most women with gestational diabetes are not screened for type 2 diabetes following delivery. ADA recommends that women be tested 6 weeks after the baby is born, and be screened every one to two years thereafter.
"Other research found that for women who were tested, providers initiated the testing only 60 percent of the time," Owens notes. "Women themselves were coming back to get tested. We need health care providers to be more proactive."
What To Do...
If you have gestational diabetes
- Get tested for diabetes 6 to 12 weeks after your baby is born, then every 1 to 2 years.
- Breastfeed your baby. It may lower your child's risk of type 2 diabetes.
- Talk to your doctor if you plan to become pregnant again in the future.
- Try to reach your pre-pregnancy weight 6 to 12 months after your baby is born.
Focus on Women
The need for more attention to the problem of how diabetes relates specifically to women led the American Diabetes Association to create the Women's Work Group in May 2006. The work group includes doctors and other medical professionals, experts from the Centers for Disease Control and Prevention (CDC), ADA staff, and volunteers from across the country. Goals of the work group include promoting advocacy efforts like the Gestational Diabetes Act as well as distributing information through the ADA Web site (www.diabetes.org) and National Call Center materials. The work group has had guest speakers from the U.S. Food and Drug Administration, the CDC, Health and Human Services, and more. For information on work group activities and how you can get involved, call the ADA National Office at 1-800-DIABETES (1-800-342-2383).