Gestational diabetes: Take action to reduce disparities
April 18, 2013 | by Hiu Chung So
Gestational diabetes may not receive as much attention as the type 1 and type 2 variants, but it can have equally serious consequences for both mother and child. Worse, its prevalence is growing in the United States.
Although often temporary, gestational diabetes is linked to a variety of complications, especially if left unmanaged. These include pre-eclampsia, a greater likelihood of Caesarean section delivery, urinary tract infections in mothers and infants, and higher perinatal morbidity and mortality. Gestational diabetes also increases the likelihood of developing type 2 diabetes for both mother and child.
Further, because the condition disproportionately affects minority populations, better research, treatment and advocacy are needed, according to a paper in the Spring 2013 issue of Clinical Diabetes.
The paper was co-written by Raynald Samoa, M.D., assistant professor in City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism, Wilfred Fujimoto, M.D., from the University of Washington in Seattle and Amy Wotring, the American Diabetes Association’s associate director of federal government affairs.
“Asian-American, Native Hawaiian, Pacific Islander, Hispanic, and African-American women are at a disparately higher risk for GDM [gestational diabetes mellitus] or its long-term effects than non-Hispanic white women ... therefore, diagnostic testing and prevention measures should be undertaken during postnatal follow-up,” they wrote.
Non-Hispanic white women have a 4.7 percent chance of developing gestational diabetes during their pregnancy, and the prevalence more than doubles in Asian Indians (11.6 percent), Vietnamese (10 percent) and Pacific Islanders (9.8 percent), the authors said, with other Asian and Hispanic populations facing higher risks, too. African-American women with the condition have a higher chance of developing complications.
Once diagnosed, gestational diabetes can be effectively managed with lifestyle changes and medication, and provisions in the Patient Protection and Affordable Care Act require health insurers to cover screening at no cost for women between 24 and 28 weeks of pregnancy. Removing this cost barrier will likely raise screening rates, especially for higher-risk minority populations, the authors said.
But the paper also said the government can do more, including passing the Gestational Diabetes Act, which would provide funding to improve tracking, surveillance and research of the condition. The act would also boost research on women in high-risk populations and how to best reduce their risk.
Introduced in 2010, the act was passed in the House of Representatives, but not in the Senate. It has received little action since, but the paper said the bill’s sponsors are committed to reintroducing the act in this Congress session.
“To protect today’s mothers and the next generation, policymakers must recognize the seriousness of diabetes,” the authors wrote, adding that the public can advocate as well through the American Diabetes Association’s Take Action page.
By taking steps now to study, prevent and better manage GDM, Samoa hopes that in the future its negative impact and disparity gap will be minimized.