gestational diabetes

CHAYA NAYAK IndiaChaya is mother to three young children and has type 2 diabetes

A window of opportunity to improve maternal and child health and slow down the diabetes pandemic

Diabetes is a growing global health emergency impacting the lives of more and more people every day

High blood sugar is one of the most common medical conditions associated with pregnancy1

415 MILLION 642 MILLION.1adults have diabetes.1

By 2040, this will rise to A person with diabetes has high blood sugar (hyperglycaemia) either because the body is not producing enough insulin or because the body does not respond properly to insulin.1

GDM appears during pregnancy and can lead to serious health risks for both mother and child.1 It is also associated with an increased risk of both mother and child developing type 2 diabetes later in life.3,4

20.9 MILLION (16.2%)live births were affected by some form of high blood sugar in pregnancy in 2015.1

85% OF CASESwere due to gestational diabetes (GDM), a temporary type of diabetes that in most cases disappears after birth.1

This rise in the number of people with diabetes is associated with ageing populations, economic development, increasing urbanisation, less healthy diets and reduced physical activity.2

GDM is the leading cause of high blood sugar in pregnancy, affecting approximately 18 million live births1

ONE IN SEVEN live births is affected by GDM1

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Untreated GDM is associated with serious short-term complications for both mother and child5,6

The risk of complications increases as maternal blood glucose levels rise.6

LARGE BABIES (MACROSOMIA) Macrosomia is common in cases where GDM is not recognised and treated. As many as 15–45% of newborns to mothers with GDM are affected.7

PRE-ECLAMPSIAWomen with GDM are at increased risk of pre-eclampsia10–13 – a leading cause of maternal deaths due to childbirth and stillbirths worldwide.14,15

STILLBIRTHS AND NEWBORN DEATHSPregnancies complicated by GDM also have a fourfold increased risk of stillbirth and death in the first week of life.8 Almost 3 million babies are stillborn every year,9

with GDM being a major contributor. OTHER COMPLICATIONSChildren born to women with GDM are at increased risk of respiratory distress, hypoglycaemia, jaundice and other complications.16

PRE-TERM BIRTHSHigh blood sugar in pregnancy increases the risk of early labour and delivery.16

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WOMEN with GDM are at increased risk of developing diabetes and other non-communicable diseases (NCDs), such as cardiovascular disease, later in life.16

Approximately

CHILDREN born to women with GDM are at increased risk of developing diabetes, obesity, hypertension and metabolic syndrome.16

Children born to women with GDM are up to

50% 8 TIMES OF WOMEN WITH GDM

go on to develop type 2 diabetes within five years of pregnancy.17

to develop type 2 diabetes3 and obesity in their teens or early adulthood.16

GDM can have a long-term health impact on both mother and child3,16,17

MORE LIKELY

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Integrating GDM testing and management into maternal health interventions can reduce both the short- and long-term impacts of diabetes

HEALTHY EATING

Lifestyle changes are often sufficient to achieve near-normal blood sugar control levels.18

EXERCISE MEDICATION (if necessary)

A number of professional and patient organisations advocate for universal testing of pregnant women to detect GDM:

International Association of the Diabetes and Pregnancy Study Groups (IADPSG)19

International Federation of Gynecology and Obstetrics (FIGO)16

International Diabetes Federation (IDF)20

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Testing for GDM during pregnancy offers a window of opportunity to reduce preventable maternal morbidity and mortality, and slow down the rising type 2 diabetes pandemic21

The Apis bull logo and Changing Diabetes® are registered trademarks of Novo Nordisk A/S. 2016 © Novo Nordisk A/S, Novo Allé, DK-2880, Bagsværd, Denmark, ZINC#HQMMA/CD/0416/0228a. Approval date: April 2016 7

REFERENCES1. International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2015. 2. World Health Organization. Global Report on Diabetes. World Health Organization, 2016. 3. Clausen TD, Mathiesen ER, Hansen T, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes the role of intrauterine hyperglycemia. Diabetes care. 2008;31(2):340–346. 4. Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet. 2009;373(9677):1773-1779. 5. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. New England Journal of Medicine. 2005;352(24):2477–2486. 6. The HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine. 2008;358(19):1991–2002. 7. Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Annals of nutrition & metabolism. 2015;66 Suppl 2:14–20. 8. Kim C. Gestational diabetes: risks, management, and treatment options. International Journal of Womens Health. 2010;2:339-351. 9. Cousens S, Blencowe H, Stanton C, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. The Lancet. 2011;377(9774):1319–1330. 10. Bryson CL, Ioannou GN, Rulyak SJ, Critchlow C. Association between gestational diabetes and pregnancy-induced hypertension. American Journal of Epidemiology. 2003;158(12):1148–1153. 11. Innes KE, Wimsatt JH, McDuffie R. Relative glucose tolerance and subsequent development of hypertension in pregnancy. Obstetrics & Gynecology. 2001;97(6):905–910. 12. Yogev Y, Langer O, Brustman L, Rosenn B. Pre-eclampsia and gestational diabetes mellitus: does a correlation exist early in pregnancy? The Journal of Maternal-Fetal & Neonatal Medicine. 2004;15(1):39–43. 13. Yogev Y, Xenakis EM, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. American journal of obstetrics and gynecology. 2004;191(5):1655–1660. 14. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. The Lancet. 2006;367(9516):1066–1074. 15. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. The Lancet. 2005;365(9461):785–799. 16. Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. International Journal of Gynecology and Obstetrics. 2015;131:S173. 17. Kim C, Newton KM, Knopp RH. Gestational Diabetes and the Incidence of Type 2 Diabetes: A Systematic Review, Diabetes Care 25, 2002. 18. Cheung NW. The management of gestational diabetes. Vascular health and risk management. 2009;5:153. 19. International Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes care. 2010;33(3):676–682. 20. International Diabetes Federation. Global Guideline: Pregnancy and diabetes. International Diabetes Federation, 2009. 21. Kapur A. Links between maternal health and NCDs. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015;29(1):32–42.

Our contributionAs a leader in diabetes care, we work to prevent, treat and ultimately cure diabetes.

In 2009, we launched the Changing Diabetes® in Pregnancy programme to create awareness of the links between diabetes and pregnancy.

Together with diabetes and maternal health communities, and through collaboration with professional societies, we are working to raise awareness of the challenges and opportunities in addressing GDM and to improve access to diagnosis and care.

See more at novonordisk.com/cdip

DIANA TORRECILLAColombia

Diana had gestational diabetes during her pregnancy

“I was really surprised to find out my condition could be controlled by physical activity and the right food,” says Diana Torrecilla, who had GDM during her last pregnancy. She was part of the Novo Nordisk-supported Vida Nueva project in Colombia.

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