February 1, 2011

Gestational Diabetes Can Affect Mothers Later In Life

Gestational diabetes, a form of diabetes that may strike during pregnancy, may disappear after birth, but it remains a potential problem for the future of the mother's health -- a warning that many seem to be missing.

Nearly half of women who have had that form of diabetes -- considered the pregnancy kind -- go on to develop Type 2 diabetes in months to years after giving childbirth.

Yet new research into the issue, conducted by Quest Diagnostics, shows that fewer than 20 percent of those women return for a crucial test within six months of delivery. That is the first of the checkups that mothers are supposed to have every few years to protect against the return of diabetes, but nobody knows how many do.

It is a serious issue because if they only knew, many of these new moms could take steps to reduce the chance of developing Type 2 diabetes later in life.

"It's almost as if you got a preview ... a window to the future," Dr. Ann Albright, a diabetes specialist with the Centers for Disease Control and Prevention (CDC), told The Associated Press. "This is a population that really should be targeted for intervention."

The American Diabetes Association (ADA) has recommended a change in how pregnant women are tested that will identify more mild cases than today, based on recent studies that found treating mothers leads to easier deliveries. If obstetricians join the cause, it could have the potential to double diagnoses -- although most mild cases would only require better nutrition and exercise regimes, and not medications, the ADA cautions.

The CDC recently estimated that nearly 26 million Americans have some form of diabetes, most of them being Type 2 diabetics linked to obesity. Tens of millions more have high enough blood sugar to be classified as pre-diabetic.

At the time of their pregnancy, women can have either Type 2 diabetes or the insulin-dependent Type 1. Women with Type 1 are urged to have their diabetes strictly controlled to avoid risks to both the baby and the mother.

But the CDC says somewhere between 2 and 10 percent of pregnant women develop gestational diabetes for the first time during pregnancy. If untreated, the mother's high blood sugar can make the fetus grow too large, leading to C-sections and early deliveries. It can also trigger the life-threatening condition preeclampsia, and may also increase the baby's risk of becoming obese in childhood.

Medical groups urge screening for most pregnant women. But nearly a third of them aren't receiving the test, according to the research by Quest.

The Quest study examined the testing records of more than 900,000 pregnant women. In some of the records, doctors may have foregone with testing because they believed the mother was at low risk. Other records suggest that mothers may not have followed their doctor's advice to get the test.

Although most mother's blood sugar levels return to normal within a few weeks after childbirth, most doctors make it clear that patients need to be checked within six to 12 weeks to be sure. Quest tracked the records for a full six months, and found 19 percent had gotten that first checkup.

"The reality is that women get busy" with their new family, said Dr. Ellen Landsberger, obstetric diabetes director at New York's Montefiore Medical Center, whose clinic takes measures to track the patients down. "Women take care of their children more than themselves," she told The Associated Press.

The CDC says that women whose gestational diabetes goes away still need their blood sugar monitored every one to three years, because they are at a higher risk of developing Type 2 diabetes within the next 10 to 20 years.

This is because the body's underlying ability to process blood sugar is forever altered, said Dr. Carol Wysham of the ADA, who heads the Rockwood Clinic Diabetes Center in Spokane, Washington.

For those women who can lose a modest amount of weight -- 5 to 7 percent of starting pounds -- and doing 150 minutes of physical activity per week are proven to prevent or at least delay Type 2 diabetes. Women who had gestational diabetes are no exception, making it even more important to lose that postpartum weight.


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