Women and Diabetes

ADA 2016 Standards of Care for Women and Pregnancy

ADA 2016 Classification and Diagnosis of Diabetes – Includes GDM Criteria

Impact of Diabetes and Pregnancy – Excerpted from Diabetes Ed Newsletter

60% of women of childbearing age are overweight or obese. Many of these women are also living with undetected prediabetes. This group of women has an increased risk of expressing hyperglycemia during pregnancy.  In some, type 2 diabetes may be detected at confirmation of pregnancy.  For many others, hyperglycemia may be discovered at 24-28 weeks, during the Oral Glucose Tolerance Test. 

During the 24-28 week time frame, insulin resistant hormones associated with pregnancy are at their peak. This insulin resistant setting acts a “stress test” for the pancreas. Pregnancy can reveal a compromised pancreas struggling to make enough insulin to ward off hyperglycemia. This is particularly true in women with risk factors for gestational diabetes including:

  • family history of diabetes, BMI >25, age >25, history of PolyCystic Ovary Syndrome, history of previous pregnancy with baby weighing > 9lbs, or a combination of these factors.

Hyperglycemia detected in this mid-pregnancy stage is termed Gestational Diabetes (GDM).  It is important to note, that some women without obvious risk factors may also develop GDM.

The number of women GDM has been increasing at an alarming rate over the past 20 years.  Currently about 9% of women have GDM during pregnancy. Rising rates of GDM is an early predictor of increasing rates of diabetes in a population.

Ongoing research is revealing that GDM affects mother and offspring’s health status, not just during the intrapartum phase, but long after delivery.

Future impact on Mother: gestational diabetes increases her risk of future diabetes by 50% within 5 years of delivery. A new study from Kaiser also shows that having GDM “elevates a woman’s risk of developing early atherosclerosis and hypertension before she develops type 2 diabetes or metabolic syndrome.”

Future impact on Offspring: Studies indicate that if a woman has GDM, her children are at greater risk for diabetes and obesity during their lifetime. It appears that the intrauterine environment, especially a hyperglycemic uterine environment, has a long lasting impact on the cardiac and vascular health of the offspring, beyond what can be attributed to genetics alone.

Link between Gestational Diabetes and Cerebral Palsy: Research tells us that gestational diabetes, may put a baby at risk for being born with cerebral palsy. A child born with cerebral palsy may be at a greater risk for later developing diabetes and other chronic illnesses. To learn more, please visit www.cerebralpalsyguidance.com


Engaging Women in the Fight Against Diabetes

Can we help stop diabetes before the risk is passed on to future generations?

With this compelling information linking GDM and future risk of diabetes, it seems that an all-out effort to reduce the rates of diabetes in women, before, during and after pregnancy, would have a tremendous impact on improving health outcomes.

Women have the potential to improve the Health Legacy we pass on to future generations.

Consider the environment; we know that other factors impact the risk of diabetes and GDM in women. Some of these factors include socioeconomic status and the environment. People with a lower income have dramatically increased risk of type 2 diabetes.  1 in 3 women in the United States, especially single moms, are living in poverty or are right at the brink of it. Another consideration is the environment. There is a direct relationship between where we live and grow up and health outcomes. Based on zip code, researchers can predict your life expectancy. Type in your zip code on this “Measure of America” website, to see how your county or state is faring. This relationship between zip code and health has to do with the settings of daily life, also referred to as our ‘built environments”, income and access to resources.

Health Care Professionals need to send a message of hope – We need to send a clear and repetitive messages to girls and women throughout all stages of life, that their health matters and that they are important. We also need to provide resources and referrals to help women improve their health status.


Key Messages during different phases of life.

Message to girls: They have the opportunity to impact the health legacy of future generations by the actions they take today. What they do matters!

Action steps:
Be active everyday. Limit screen time to 2 hours a day, engage in 1 hour of moderate intensity exercise daily.

Eat healthy. Limit sweet drinks like soda and fruit juices and limit processed foods.

  • Talk to girls about BMI and address weight issues early on. Refer to dietitians and community programs.

Message to Young Adult Women: Get to and maintain a healthy weight before becoming pregnant.

Action Steps:

Message to Women During Pregnancy 
Focus on getting to your best health. Try not to exceed recommended weight gain, keep active, and keep connected to health care team for recommended tests and checkups.

Action Steps:

  • Less than 30% of women gain the recommended weight during pregnancy.  Stressing to women the importance of not exceeding their weight gain goal is very important for their health and the health of the baby. Gaining excessive weight increases risk of GDM by 50% along with having a large baby.
  • Refer to community programs and registered dietitians to help women meet weight goals.

Message to Women After pregnancy– There is so much you can do to improve the Health Legacy of you and your child.

Action Steps: Breastfeed, keep active, eat healthfully, get glucose tested 6-12 weeks after delivery. 

See this handout for more info

Breastfeeding benefits.

Rates of breastfeeding are on the rise.  More than 75% of women initiate breastfeeding and by one year 25% are still breastfeeding. See 2013 Breastfeeding report card. There are many barriers, including lack of social support, lack of paid leave and lack of onsite childcare. Since breastfeeding provides a tremendous benefit for the child, mom and society, we need to keep encouraging women to breastfeed and help decrease barriers to success.

Screen for Diabetes in GDM 6-12 weeks after delivery.

  • Only about 30-50% of women return for this important recommended screening to evaluate blood glucose levels.

Whether or not they return for screening, encourage women to get an annual screening test for diabetes. They can even use their baby’s birthday as a yearly reminder. Undetected diabetes can cause complications. Undiagnosed diabetes during early pregnancy can lead to miscarriage and birth defects.

Health care professionals also need to discuss the importance of getting active, getting to a healthy weight and role modeling healthy eating for their families. Referrals to dietitians and community weight loss programs help women success.

Health Legacy and Message of Hope: Gestational diabetes is often a disappointment for women. Though challenging, we can present this as an opportunity to improve their health and prevent diabetes for the mom, her children and future generations.

As a community of health care professionals, we can provide women with support, encouragement and clear action steps they can take to help win the fight against diabetes.

Sweet Success Web Page
A resource for health providers and women alike. Offers training programs and resources on diabetes in pregnancy.
 

Reducing Diabetes Risk after GDM
If you want to provide your patient with GDM strategies to prevent future diabetes, this is an excellent handout. It discussed the proven benefits of the Diabetes Prevention Program.
 

Gestational Diabetes Linked to Heart Disease in Midlife – this article published by Kaiser Permanente explores the link between GDM and heart disease.
 

2013 Breastfeeding Report Card for the United States
A comprehensive overview by state on the current state of breastfeeding. Includes great resources and helpful information on promoting breastfeeding.

Erb’s Palsy – Erb’s Palsy affects the nerves within the neck that control the motions of the arm. Gestational diabetes is a maternal health condition in which diabetes is diagnosed during pregnancy. Its most common complication or injury is macrosomia (macrosomic babies weight over 4,000 grams), which can lead to birth injuries including hypoxic ischemic encephalopathy (HIE), brachial plexus injury, Erb’s palsy, and cerebral palsy (CP). Cerebral Palsy Group is here to help provide information, resources, and support to families in need. To learn more about about diabetes and Erb’s Palsy complications check out Cerebral Palsy Group. 

Patient Resources

Gestational Diabetes Resource Sheet – A fantastic handout full of resources that provides info and action steps for women with GDM. Also discusses strategies to prevent future GDM. Upbeat and user friendly.

ADA Info Page for Patients – What is Gestational Diabetes? – Offers basic information on GDM along with other links and a podcast.

Diabetes Sisters Website – Diabetes Sisters offers a range of education and support services to help women of all ages with all types of diabetes live healthier, fuller lives.

Women and Diabetes – ADA

Offers a variety of helpful information focusing on women’s health issues and answers questions regarding diabetes.


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