For the past 30 years, the happiest experiences I've shared with my patients are their pregnancies. But increasingly, pregnancy is the moment of truth for them-a wake-up call about the need to take charge of their health.
A growing number of South Asian mothers are at high risk for a silent, deadly threat: Gestational Diabetes Mellitus (GDM). It's a condition during pregnancy in which women never previously diagnosed with diabetes exhibit high blood sugar (glucose) levels.
Although GDM is on the rise across all populations, South Asian women have the highest rate of GDM-14 percent of pregnancies-which is twice the average rate for the general population. GDM not only can threaten a mother's health, but also have long term health consequences for her baby.
Prevention and control-even before a woman becomes pregnant-is critical. Why is prevention so important? GDM is a significant health threat to the mother and baby both during pregnancy and after delivery.
During pregnancy undiagnosed uncontrolled early Gestational Diabetes can cause pregnancy loss or a heart defect in the baby. Later in the pregnancy it can cause the baby to gain excess size and body fat that necessitates a C-section delivery.
After delivery, mothers who develop GDM have a one in three chance of later developing Type II diabetes, and have a higher risk of stroke. Their babies have a significantly increased lifetime risk of becoming overweight, obese or developing diabetes, too.
These serious complications of GDM can and should be avoided. The good news is that a combination of diet and exercise before and during pregnancy can prevent or control GDM-and set both mother and baby on a lifelong course of better health.
I often am able to work with high risk patients because they are finding it difficult to become pregnant due to irregular cycles. I like to start them on a healthier path right away, using their focus on getting pregnant to persuade them to see a nutritionist, join a gym and get a diabetes test. I explain that unless they make changes, they are likely to experience a high
risk pregnancy that may place their baby at risk.
The first step is a screening test for diabetes. It is more sensitive to obtain a post meal blood test. I often refer my high risk, not-yet-diabetic patients to the
South Asian Heart Center at
El Camino Hospital, established to help South Asians identify their individual heart disease risk (often closely associated with the risk of diabetes) and lower it through diet, exercise, and medical intervention when warranted. If my patients test positive for diabetes before they are pregnant they see the nutitionist and diabetes educator at El Camino Hospital. (They are an excellent resource for our patients.) We are also fortunate to have the Sweet Success program in the Bay Area and the low cost nonprofit Diabetes Society of Santa Clara
Valley. I often also have them go to the
DiabetesIndia.com website to obtain more information on the various Indian food calorie counts.
When it comes to GDM I take an aggressive approach with all my pregnant South Asian patients. We are fortunate that most centers in California follow the guidelines of the International Association of Diabetes and Pregnancy Study Group (IADPSG) . These stricter guidelines, endorsed by the American Diabetes Association, call for earlier screening in the first
trimester (first OB visit) and again between 24 and 27 weeks.
The current guidelines are more convenient, better tolerated and more sensitive for identifying the pregnancy at risk for adverse outcome. I will often screen at the first visit with a Glyco hemoglobin and/or fasting blood sugar, then a 24-week 75 gm. two-hour screening, followed by a 27-28 week screening. I may repeat again after 34 weeks if the mother gains excess weight in a short interval.
I take these steps because diabetes is rampant in Asian communities and my patients' family medical histories are likely to be unreliable. We are ticking time bombs, yet many Indian families are in denial about their history of diabetes, as I know from personal experience. When my own husband tested positive for high glucose, I cajoled his family into being tested, despite his mother's insistence that no one in the family had ever had diabetes. All but one sibling proved to be diabetic!
Instead of asking about diabetes, I now ask if anyone has had "a touch of sugar." I usually get a long list of names!
Preventing GDM-and diabetes in general-is not easy, and it takes more than just diet modification. When my patients ask, "What can I do?" I tell them exercise, exercise, exercise! I tell them to locate support groups, group discussions, and find a buddy who will provide positive reinforcement. I tell them to keep a gym bag in the car-and not go home until they've done
their exercise. (Exercise is essential; the Diabetes Prevention Program study revealed that exercise and moderate weight loss sharply reduces the chance of developing diabetes.)
I also tell my patients to be kind to themselves, and to not let small setbacks sabotage their overall efforts. Missing one day is just that: missing one day.
On a positive note, GDM can be a blessing. This early warning sign for Type II diabetes provides a chance for women to make lifestyle changes and get blood sugar under control before damage has been done. And, patients who stick with those changes will be rewarded not only with healthier pregnancies but with better overall health-as well as the knowledge they are serving as a positive role model for their children and their families.
Irregular cycles often are due to a condition called Polycystic Ovary Syndrome (PCOS), which also causes increased facial hair growth, acne and oily skin and obesity. It's a risk factor both for GDM and cardiac disease.
(Dr. Prasanna Menon, MD, practices obstetrics and gynecology at El Camino Hospital in Mountain View, CA. A tireless advocate for research about the underlying causes of health disparity in the South Asian community, she helped mobilize community support for the launch of the South Asian Heart Center at El Camino Hospital, the first nonprofit, community-supported center devoted to the prevention of coronary artery disease (CAD) in people of South Asian descent.)