Alarm over undiagnosed diabetes in pregnancy

THERE HAVE been calls for standardised diabetes screening for expectant mothers after a new study has shown that in pregnancy the disease is going undiagnosed and untreated.

Women who develop gestational diabetes mellitus (GDM) – the most common medical problem among pregnant women – run a seven times higher risk of developing type 2 diabetes after their pregnancy. The condition is also associated with premature births, Caesarean deliveries, large babies, and a three times higher likelihood of neo-natal ICU admission.

The latest findings from the unique Atlantic-DIP (Diabetes in Pregnancy) study, carried out by the school of medicine at NUI Galway, shows a significant increase in recorded diagnoses of GDM between 2005 and 2010, but because only a selective group of high-risk women was screened, many cases are going undiagnosed and untreated.

The HRB-funded study shows that the prevalence of GDM is 12.4 per cent in expectant mothers in Ireland when adopting a universal screening approach. There will be an estimated 70,000 deliveries in Ireland this year.

However, a spokesman for advocacy group Diabetes Action pointed out that GDM screening continued to be offered inconsistently and diagnostic criteria varied from one part of the country to another. At present screening for GDM did not even form part of the HSE’s maternity and infant care scheme, which all expectant mothers were entitled to receive free from their GPs, he said.

Prof Fidelma Dunne, head of the school of medicine at NUI Galway and principal investigator on the Atlantic-DIP study, explained that the ongoing follow-up study identified that 30 per cent of women with GDM had developed type 2 diabetes within five years of the index pregnancy.

“GDM is the most common medical problem among pregnant women. Among the risk factors are age, being overweight and physically inactive. Overweight and obesity in pregnancy is a growing and significant problem contributing to GDM and affecting 58 per cent of women. Additionally and irrespective of the association of GDM, it is also causing independent health problems for mother and infant,” said Prof Dunne.

Both Diabetes Action and Diabetes Ireland are calling for national standardised screening for GDM to be available to expectant mothers from their GPs. Diagnosed women should then be referred to see a multi-disciplinary team in an anti-natal or diabetes clinic within two weeks of being diagnosed with GDM.