Gestational diabetes mellitus (GDM) is a very serious condition that affects the health of the mother, as well as her baby in varying time periods: immediate, short-term, or long-term. It is a type of diabetes that affects pregnant mothers and has the potential to recur despite the fact that it mainly disappears after birth. This paper is aimed at enhancing the understanding of GDM among Australian pregnant mothers with a focus on its prevalence, causes, health implications, established policies and public initiates aimed at addressing it, as well as future strategies and approaches that could help reduce its incidence and prevalence.
The prevalence of gestational diabetes worldwide has shown a general increasing trend in the last 20 years across race/ethnicity groups. According to recent data by Ferrara (2007), an increase of approximately 10 to 100% has been reported in various race/ethnicity groups. In Australia, the prevalence of GDM is estimated to range between 5.2 and 8.8% (Cheung & Byth 2003). The 2005-6 gestational diabetes mellitus in Australia report gave a figure of 4.6% to represent the fraction of pregnant women aged 15-49 years with GDM. This was a 20% increase compared with what had been recorded in 2000-1 (Templeton & Pieris-Cladwell 2008). According to this report, the incidence of gestational diabetes was increasing. This is seconded by Ferrara’s (2007) in his research work, in which he showed increasing trends in the prevalence of GDM in various geographical regions where South Australia was part. On an annual basis, 16,500 women are diagnosed with GDM (Dodd et al. 2007). Unfortunately, this is expected to continue growing.
There is no definite known cause for GDM but there are different facts and theories presented to guide this. One version is that during pregnancy, the hormones responsible for foetal growth and development impede the action of insulin hence insulin resistance (Australian Government and Diabetes Australia 2010). Based on this theory, it is automatically presumed that when the release of the blocking hormones stops, then the insulin levels go back to normal. As a result, it lacks a definite cause. Alternatively, risk factors are used to explain the cause of GDM as stated by Jovanovic & Pettitt (2001). These risk factors among others include obesity, maternal age, and a family history of diabetes. The fact that a pregnant woman gets GDM for the first time during their pregnancy is a risk factor in itself because histories of GDM are associated with high chances of developing the disease in subsequent pregnancies (Hall 2001).
Racial differences are also very imperative in determining the occurrence of GDM. This can be supported by the fact that the prevalence of GDM was reported to be higher in Chinese and Indian women residing in Australia compared with the women of European or Northern African descent, who were residing in Australia as well (State Government of Victoria 2012). In addition, the Aboriginal women rather than the non-Aboriginal women were more exposed to this type of diabetes (Ishak & Petocz 2003). The 2005-6 GDM report simply states that the incidence of GDM among women who had been born from other countries was twice as large as the incidence of those women born in Australia. Those born in Southern Asia were 3.4 times more at risk of getting the disease compared with those born in Australia (Templeton & Pieris-Caldwell 2008).
Gestational diabetes mellitus is a public health issue with serious implications. As stated earlier, its implications are felt almost immediately, in the short-term, or long-term. The implications of GDM are mainly felt by the infants in the newborn period. This is because of the current patterns that show an increase in the prevalence of diabetes in offspring born to mothers with GDM (Ferrara, 2007). Short-term-effects mainly include those that are observable or detectable during pregnancy, labour and a short time after birth and inexhaustibly include outcome of pregnancy, intensive care admissions, duration of pregnancy, need for resuscitation, method of delivery, foetal growth characteristics, and type of labour (Australian Institute of Health and Welfare 2010).
Neonates born to mothers with GDM experience the implications of GDM in the following ways: increased exposure to stillbirth, respiratory distress syndrome, caesarean section, shoulder dystocia, and macrosomia (Gonzalez-Quintero et al. 2007). Stone et al. (2002) implies that babies born to mothers with GDM are more at risk of going through the effects of this disease compared with babies of non-GDM mothers. This is due to the facts presented; whereas 17% of neonates from mothers with GDM were macrosomic, only 10% of the neonates from mothers without GDM had the condition, 13% of the newborns from mothers with GDM had neonatal jaundice compared with 7% of non-GDM mothers, and 32% of the newborns from mothers with GDM were delivered by caesarean compared with 19% of newborns belonging to mothers without GDM. Suhenon & Teramo (1993) indicate that GDM exposes pregnant mothers to pregnancy-induced hypertension and pre-eclampsia, operation during delivery, and induced labour. According to a study carried out in Victoria in 1996, 37% of women with GDM compared with 23% of women without GDM had induced labour. In addition, 41% of the women with GDM underwent operative delivery by means of vacuum extraction, forceps, or caesarean as opposed to 29% of women without GDM (Stone et al. 2002).
The long term implications of GDM to the mothers include increased risk of recurrent GDM in subsequent pregnancies. In addition, it results in progression to type 2 in these mothers and a general resultant effect of high prevalence of type 2 diabetes in general. It is has been estimated that 17% of Australian women with GDM are later diagnosed with type 2 diabetes within 10 years. These figures can go up as high as 50% when the timeframe changes to 30 years (Lee, et al., 2007; Metzger 2007). The explanation behind this is that the prevalence of GDM has been indicated as a reflection of the prevalence of type 2 diabetes in the larger population. In addition, it is the attributive risk factor for type 2 diabetes among the pregnant mothers with GDM (Kim, Newton & Knopp, 2002).
GDM posses as a serious health risk for pregnant mothers because it also exposes them to heart diseases according to Retnakaran & Baiju (2009). Women with GDM have an increased risk of neonatal hypoglycaemia, and hyperbilirubinaemia. The babies are also affected in the long term because they tend to have congenital anomalies. They also have an increased risk of obesity, impaired glucose tolerance, and are also susceptible to type II diabetes in early adulthood (Fetita et al. 2007).
As a result of the need to reduce associated co-morbidities and death, there have been initiatives put in place to ensure that GDM is reduced and lives are saved. The government has been involved in funding Diabetes Australia for the successful development and execution of effective mechanisms to reduce the incidence and prevalence of GDM (Australian government 2012). The National Diabetes Services Scheme (NDSS) is a project that was initiated by the Australian government through Diabetes Australia, and its role has been greatly recognized in as far as reduction and prevention efforts of GDM are concerned. Within the National Diabetes Services Scheme, there is the National Gestational Diabetes Register that was set up to enable women with GDM to gain control over their conditions and ensure that their health conditions do not worsen (Diabetes Australia, 2012).
Pregnant women are required to register with this body, the National Gestational Diabetes Register, and in return they are to receive some benefits. Their doctors and they are sent consistent reminders of the need to engage in diabetes checks. In addition, this body is involved in sensitizing and providing information in printed form to the women on the need of, and how they should adopt a healthy lifestyle. However, this does not guarantee that the women will actually read and understand the information. Therefore, it could be a reason for the continued increase because even though there is sensitization, the manner in which it is carried out matters a lot.
As indicated earlier, one’s lifestyle is a great determinant to one’s health and especially diabetes including GDM. Sometimes, individuals are not knowledgeable in as far as healthy diets are concerned, or they may not realize the essence of such diets. Consistent provision and distribution of printed materials on GDM and how it can be controlled is assumed to act as consistent reminders on the need to ensure that one adopts and practices healthy feeding habits. But this medium of passing information is questionable. This registration has been made free and therefore every pregnant woman is not restricted by money to get the reading materials, and engage in medical check-ups. Regardless of this free service, thoroughness in terms of follow-ups should be observed because the women act out of their own will and it might not be consistent. Such free services deserve more emphasis and should not be viewed as opportunities for only the less privileged because they are equally important to everyone.
Registration with NDSS also enhances one’s access to various products such as testing strips, insulin syringes and pen needles, and insulin pump consumables. These devices are very important in the management of GDM through monitoring of one’s glucose levels. It should not just be a matter of distributing these devices because if someone does not know how to effectively and properly use and take of this equipment, it would be a goalless venture. Ensuring that there is available data on the incidence and prevalence rates of pregnant women with GDM is another initiative. This data has been made available in the Gestational diabetes mellitus in Australia report. The first one was developed in 2005-6 and it aimed at providing researchers, scholars or related academicians with information on the incidence of GDM among women giving birth in hospitals. This report also provided information on high-risk sub-groups, which are defined on the basis of their orientation towards the condition. Factors mentioned in this report that determine inclination towards the disease include age and genes (Templeton & Pieris-Caldwell 2008).
A realization is that despite the strategies in place currently, the prevalence of GDM is still increasing. This could mean several things but in future, there is need to carry out researches and establish the effect of each strategy in reducing GDM and therefore establish their effectiveness, as well as what is not addressed by the various strategies. The world is constantly changing and therefore, there is need to constantly review and update data. Researchers should exercise validity because there lacks consistency in the levels of incidence and prevalence of GDM. Yet, this is very important in planning and allocating resources to address GDM in the future. Accurate figures enable the government and various bodies addressing diabetes to focus. I second Lancaster (1996) on the essence of enhancing the research area so as to give consistent and reliable results.
The main challenge is usually maintenance. Once the glucose levels have gone down, there is a tendency for women to assume that they are okay and therefore tend to ignore the monitoring bit. This is a reflection of the NDSS scheme where follow-up lacks and therefore, this element should be given full attention. There is need to clearly point out the essence and ways of maintaining a normal glucose level and especially for those mothers who have experienced GDM before so as to avoid its recurrence. Lack of follow-up is an indication of lack of seriousness. The notion by health care workers that diabetes is just like any other disease, and that they do not put much seriousness are elements that may have certain effects on the patients. As a result, the women may miss out on some fundamental practices that can affect their prognosis and road to recovery.
A lot of emphasis is mainly placed on the pharmacological dimension of GDM yet behavioural interventions such as healthy eating, engagement in healthy physical activity and proper stress coping mechanisms are more effective in reducing the recurrence of the disease but are not accorded the required attention and emphasis (Australian Government and Diabetes Australia 2010). There should therefore be a shift in emphasis where women should be really encouraged to change their lifestyles and adopt healthier ones, or maintain the healthy ones. Counselling services should be offered affordably, or as part of the NDSS package to ensure that all mothers benefit. To enable such utilization of services to enhance behaviour change, there is need to evaluate the accessibility of health care services among the GDM mothers and thereby figure out if there is a way that accessibility could be enhanced. Examples here would include subsidizing health care costs with a focus on the individual’s background financial position.
Future strategies should not focus solely on the GDM but instead, they should also encompass the associated type of diabetes that results. In essence, the strategies to address GDM should be designed in such a manner that also minimizes the occurrence of type II diabetes. The successful implementation of projects and policies is grounded in integration and co-operation among the involved parties. The various health care systems entail various departments and all these should liaise effectively with one another through effective communication to avoid inefficiencies and deficiencies in the system. These inefficiencies and deficiencies are so serious such that regardless of the great advocacy and accessibility to health care, lack of co-ordination results in poor delivery of services and may not produce the desired effect on the patient.
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