Friday, June 26, 2015

Gestational Diabetes Takes Toll on Texas Moms and Babies

For many women, expecting a child is full of exciting new experiences, but many also face an unexpected health problem along the way: diabetes.

The most common form of diabetes pregnant women encounter — gestational diabetes mellitus (GDM) — is more prevalent than experts once thought, according to a new Medicaid report.

The report, Gestational Diabetes in Medicaid: Prevalence, Outcomes, and Costs, released by the Texas Health and Human Services Commission (HHSC), finds diabetes among women of childbearing age grew 40 percent from 2002 to 2012.  It suggests that “as many as 9 percent of all pregnant women in Texas may develop GDM prior to delivery.” That’s more than 18,000 women.

What it is

GDM occurs when a pregnant woman’s body is unable to make and use all the insulin she needs for pregnancy, making it difficult to convert blood glucose (blood sugar) into energy. GDM disappears after the baby is delivered, but in many cases it returns years later as type 2 diabetes.

According to the American Diabetes Association, the risk for developing GDM is about twice as high for overweight women, four times higher for obese women, and eight times higher among severely obese women, compared with normal-weight pregnant women.

Why it matters

Diabetes can affect the pregnant woman’s health, whether she carries the baby full term, and the health of the baby. The HHSC report says three groups of pregnant women — those with GDM, with pregestational diabetes mellitus (PGDM), or who are overweight or obese — are more likely to give birth before 37 weeks or require surgery to deliver the baby (a Caesarian section, or C-section). Obese women with PGDM are especially at risk; the report says they are four to seven times more likely to develop hypertension and require C-sections or need to be admitted to a hospital’s intensive care unit.

GDM affects the newborn as well as the mother. The Texas Department of State Health Services reports 12.5 percent of all infants born to diabetic mothers needed special care from a neonatal intensive care unit.

Not only is gestational diabetes unique in that it affects two people — the mother and her child — but also it keeps the diabetes cycle going for the next generation.

“If half of these children are girls, and they’re already overweight in their teenage years and stay that way, the whole cycle is going to repeat,” said John Menchaca, MD, a Fort Worth pediatrician.

Dr. Menchaca says in his 35 years of caring for patients, he frequently saw overweight children of diabetic mothers. Because of the mother’s GDM diagnosis during pregnancy, these infants already have an increased risk for diseases and conditions like heart disease, high blood pressure, obesity, and type 2 diabetes.

“It’s very bothersome,” he said. “It has significant adverse effects on the offspring to have a mother with gestational diabetes, or maternal obesity, or having gained a lot of weight during pregnancy.”

Texas physicians say obesity during pregnancy is a preventable health condition that poses significant risks for mothers and infants. Texas Medical Association policy recommends women receiving prepregnancy counseling be informed of the risks of obesity in pregnancy for both mother and baby, and be encouraged to undertake a weight-reduction program.

Identifying and treating overweight and obese young women “basically starts the prevention process, before the next generation is conceived,” Dr. Menchaca said. “It’s exceedingly hard to achieve … but we can’t do nothing.”

For more on GDM’s toll on Texas, including its financial costs, check out the June issue of Texas Medicine magazine.

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