Mothers Risk Their Health by Failing to Return for Diabetes Testing
Pregnancy diabetes or gestational diabetes is a temporary form of the disease which affects women, usually towards the middle of their term. It does not harm the growing fetus and usually does not require medical treatment other than care with the diet. It almost always disappears after the birth of the baby.
However, pregnancy diabetes is an indicator that the woman has an increased risk of developing type 2 diabetes later in life. Some races and those who need insulin during the gestational diabetes are at greater risk. Doctors and obstetricians will advise the mother-to-be that she should watch for signs of diabetes in later life and have regular check-ups.
Gestational diabetes affects around 18% of pregnancies but is not associated with birth defects. Hormones from the placenta block the action of insulin in the mother’s body, causing high blood sugar levels. This may be associated with macrosomia, the development of a larger baby, which can cause problems with delivery. The child then faces an increased risk of becoming obese later on because it has high insulin levels secreted to counter the mother’s high blood sugar.
Pregnancy diabetes is usually managed with careful diet and exercise, and does not always require treatment with insulin or other medication. However, a mother who has pregnancy diabetes has a two in three chance of getting the condition again with future pregnancies as well as a higher risk of type 2 diabetes later in life.
A recent study showed 22% of women with gestational diabetes had glucose intolerance or total diabetes after giving birth – yet less than half of the study group returned for testing after the birth. Doctors have come to expect that women with the condition typically do not return for check-ups after the birth, believing all will be well once the baby has been born. This denies them the opportunity for early diagnosis of type 2 diabetes, which would give them a medical advantage over people diagnosed by chance. Diabetes is typically not diagnosed for several years, by which time complications may have set in, so early diagnosis is desirable.
The study looked at 396 women with gestational diabetes, only 47% of whom returned for follow up appointments after the birth of their child. Of these 189 women almost a fifth were found to have impaired glucose tolerance or diabetes – meaning a fifth of those who did not return may well have had diabetes or pre-diabetes that remained undiagnosed and untreated.
“The biggest thing about postpartum testing is the poor rate of compliance,” said Dr Boyd Metzger from the Northwestern University Feinberg School of Medicine. We need a new strategy for testing postpartum because we will lose even more.”
Dr Metzger added that the severity of the diabetes in pregnancy, whether insulin or other medication was needed, added to racial predisposition, is a very accurate predictor of type 2 diabetes in later life. The worse the diabetes is the sooner the patient might expect the permanent condition to develop, so it is more vital that these patients follow medical advice and return for check-ups.
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