Gestational Diabetes Mellitus: A Global Prevention StrategyGestational diabetes mellitus is a common cause of perinatal maternal and fetal morbidity and mortality worldwide. The condition has been explored since the middle of the 1900s, and to date, several strategies for screening and treatment have been identified and developed. This principally involved identification of pregnant women who are most likely to suffer from glucose intolerance or hyperglycemia during the period of pregnancy and are, therefore, more prone to suffer from the adverse effects of too high a sugar in the blood.
Treatment principally involves dietary modification or insulin injections, depending on the severity of the condition. This paper explores the possibility of instituting a global prevention strategy to decrease, if not totally eradicate, gestational diabetes mellitus. In the succeeding paragraphs, the definition of gestational diabetes mellitus is discussed, as well as the current epidemiologic burden of the condition. Then the literature is reviewed as to the possible sites of intervention to prevent the occurrence of gestational diabetes mellitus. Finally, a public health policy to prevent gestational diabetes mellitus is proposed based on the literature reviewed. Gestational diabetes mellitus: Definition and epidemiologyGestational diabetes mellitus is currently defined as variable severity of glucose or carbohydrate intolerance first recognized during pregnancy, which may or may not require therapy in the form of dietary modification or insulin injections, and which may or may not persist after pregnancy (Coustan 1995; Bottalico 2001; Brody, Harris, Whitener, Krasnov, Lux, Sutton & Lohr 2003; American Diabetes Association 2004; ‘Diabetes’ 2005).
Gestational diabetes mellitus complicates 2 per cent to 5 per cent of pregnancies annually worldwide and has a reported prevalence of anywhere from 1 per cent to 14 per cent, with figures varying across regional groups as well as the test employed to make the diagnosis (Coustan 1995; Brody 2003; American Diabetes Association 2004). Identified risk factors for the development of gestational diabetes mellitus include advanced maternal age, a family history of diabetes in a first-degree relative, obesity (pre-gravid, measured through the body mass index), glycosuria, and a lack of pre-gravid exercise (Coustan 1995; Brody et al 2003). These risk factors have been utilized to stratify the risk of women to develop gestational diabetes mellitus when they become pregnant, as it was found that the prevalence of gestational diabetes mellitus actually increases as the number of risk factors also increases (Brody et al 2003).
A woman is said to be low-risk when she is a member of an ethnic group with low prevalence of gestational diabetes mellitus, no known first-degree relative with diabetes, age less than 25 years, normal pre-gravid weight or a “body mass index less than 25 kilograms per meter of height squared, kg/m2”, with no history of glucose intolerance, and with no prior poor obstetrical outcome (‘Diabetes 2005).
The prevalence of gestational diabetes mellitus in this low-risk segment is 1.4 per cent to 2.8 per cent (Brody et al 2003). Marked obesity, a strong family history of diabetes, prior gestational diabetes mellitus, or membership in certain ethnic groups (Hispanic, African, Native American, South or East Asian origin) confer on a woman a higher risk (prevalence = 3.3 per cent to 6.1 per cent)of developing gestational diabetes mellitus (Brody et al 2003).