By Katja Iversen | The British Medical Journal | 2 May 2017
Over the past two decades, improving maternal health has become an increasingly important focus of the global development agenda—and rightly so. Between 1990 and 2015, the maternal mortality rate has fallen by 44%, from approximately 546,000 to 303,000 deaths per annum. That reduction is a testament to the sterling collective efforts of governments, institutional donors, health service providers, and family planning agencies, as well as tireless campaigning by international, national, and grassroots organisations.
Yet despite these gains, some 830 women and girls still die from preventable causes related to pregnancy and childbirth every single day. These deaths are unacceptable. Clearly, the approach needs to change if there is any hope of meeting the Sustainable Development Goals target to reduce the global maternal mortality ratio from its current 216 deaths per 100 000 live births to less than 70 deaths per 100 000 live births by 2030.
To achieve this ambitious target, the global health community must tackle previously neglected conditions that are associated with pregnancy complications, and which are thereby responsible for the unacceptably high numbers of maternal deaths each year. Diabetes in pregnancy is one such condition, affecting one out of every six pregnancies around the world.
Diabetes in pregnancy includes women who have previously been diagnosed, as well as those who exhibit high blood glucose (blood sugar) levels and develop gestational diabetes mellitus (GDM) during their pregnancies. Left untreated, GDM can have devastating consequences for mother and baby alike. There are proven links, for example, between GDM and the risk factors that contribute to maternal mortality, like postpartum haemorrhage, obstructed labour, and pre-eclampsia.
Children born to mothers with untreated GDM face increased risk of neonatal death and long term disability. Furthermore, children born to mothers with GDM are four to eight times more likely to develop type 2 diabetes in later life, while daughters of affected mothers are more likely to be similarly affected during any future pregnancy of their own.
Diabetes in pregnancy is on the rise globally, due to changes in lifestyle and dietary habits, and it currently affects some 14 million women every year. As with most problems related to pregnancy complications, diabetes in pregnancy is more prevalent in low and middle income countries, which account for 88% of cases worldwide. Yet the countries where diabetes in pregnancy is most prevalent are the least likely to offer routine screening and treatment.
The public health challenge of diabetes in pregnancy is immense and pressing, and any concerted efforts to raise awareness and confront the problem are relatively recent. The XXI FIGO World Congress of Gynaecology and Obstetrics in Vancouver (2015) adopted new global guidelines on how to screen and manage GDM, and the World Diabetes Foundation hosted a panel on the subject at last year’s Women Deliver Conference in Copenhagen. Practical interventions are also underway. In 2011 the World Diabetes Foundation collaborated with others in Columbia to integrate GDM diagnosis and treatment into prenatal care for vulnerable women in the city of Barranquilla. Yet much still remains to be done.
There is a strong need to build bridges between the diabetes and the maternal and newborn health communities to promote joint action around diabetes in pregnancy—particularly in the high burden countries of India, China, Indonesia, Pakistan, Bangladesh, Nigeria, Mexico, and Brazil. Without this cooperation, the global development sector risks curtailing the great progress that has been made in improving maternal health over the past two decades. By including universal screening for diabetes as a standard of care for pregnant women, there is an opportunity to improve health; save lives; and promote prevention efforts, like nutrition and physical activity, which will improve wellbeing for generations to come.