Gestational Diabetes and African-American Women's Health

What Is Gestational Diabetes?

According to the American Diabetes Association (ADA, 2011), gestational diabetes affects about 4% of all pregnant women in the United States — approximately 135,000 women per year. Scientists currently do not have a definitive cause for gestational diabetes. Elevated blood sugar levels develop when the pregnant mother is unable to produce the insulin her body requires during pregnancy. When the body cannot produce enough insulin, glucose cannot be converted into energy; instead, it accumulates in the bloodstream and reaches elevated levels. Scientists speculate that hormones from the baby's placenta block the action of the mother's insulin. Diabetes is most commonly understood as a dysfunction of the pancreas, in which the organ cannot produce sufficient insulin to support the body. Gestational diabetes is different: the pancreas does produce insulin, but its action is inhibited by the placenta. After delivery, most women return to normal glucose tolerance levels (Anderwald et al., 2011).

There are very few noticeable symptoms of gestational diabetes. Only a small percentage of women experience increased thirst and frequent urination as signs of the condition. Pregnant women are urged to undergo routine examinations during pregnancy, which can aid in the diagnosis of gestational diabetes or any other medical condition.

Diagnosis and Risk Factors

Gestational diabetes is diagnosed using a routine procedure called the glucose challenge test. The pregnant woman is given 50 grams of glucose to drink, and one hour later her blood glucose level is measured. If the result shows an elevated blood glucose level above 140 milligrams per deciliter, she is referred for a second, more comprehensive test known as the glucose tolerance test. An elevated glucose level on this second test confirms a diagnosis of gestational diabetes.

Typically, women over 30 years of age who are overweight are more likely to develop gestational diabetes (U.S. Health, 2011). Women with a strong family history of diabetes, or who had gestational diabetes in a previous pregnancy, are also at elevated risk. Additional risk factors include having previously delivered a baby weighing over nine pounds, living in an impoverished neighborhood, and having inadequate access to medical care. Women at risk for gestational diabetes are advised to reduce their dietary intake of iron, as high levels of dietary iron early in pregnancy are associated with increased risk of the condition (Bowers et al., 2011; Qiu et al., 2011).

Treatment of Gestational Diabetes

Patients diagnosed with gestational diabetes are typically offered a structured treatment program. Pregnant women are encouraged to attend educational classes that help them understand their diagnosis. Most obstetricians aim to prevent hospitalization by ensuring that patients are sufficiently educated about their condition. Midwives are often employed to provide counseling and other forms of health support for gestational diabetic patients (Persson et al., 2011).

One of the most important ways of managing gestational diabetes is through proper diet and exercise. Pregnant women receive guidance on pregnancy-appropriate diets designed to lower blood sugar levels, sometimes without the need for medication and sometimes in combination with pharmacological treatment. Women who are unable to manage their gestational diabetes through diet and exercise alone use insulin to control their blood sugar. Insulin is the preferred pharmaceutical treatment for gestational diabetes because it does not cross the placenta and therefore does not harm the baby. In recent years, other medications have been developed that are considered fairly safe for the baby and are still being evaluated (Coustan, 2007).

Glyburide is the leading oral medication for treating gestational diabetes and carries the fewest side effects. A comparison of insulin and glyburide found that glyburide is more cost effective than insulin therapy (Goetzl & Wilkins, 2002).

Conclusion

Gestational diabetes is a serious condition affecting many women during pregnancy. It is important for women to become educated about this disease, as doing so will help them control their blood glucose during pregnancy and protect their long-term health after delivery. Women with gestational diabetes face a high risk of developing type 2 diabetes in the years following delivery. While there are many risk factors associated with diabetes, developing gestational diabetes is itself a major predictor of future diabetes diagnosis. Minority women — especially African-American women — are at greater risk for this disease. Lack of access to health care is a significant contributing factor for minority women developing gestational diabetes. Health education is critically important: it helps women understand the disease and empowers them to take protective action. Diet and exercise remain the most important variables in controlling or preventing diabetes.

References

ADA (2011). What is gestational diabetes? American Diabetes Association. Retrieved from http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html

Anderwald, C. et al. (2011). Glucose absorption in gestational diabetes mellitus during an oral glucose tolerance test. Diabetes Care, 34(7), 1475–1480.

Bowers, K. et al. (2011). A prospective study of prepregnancy dietary iron and risk for gestational diabetes mellitus. Diabetes Care, 34(7), 1557–1563.

Coustan, D. R. (2007). Pharmacological management of gestational diabetes. Diabetes Care, 30(2), 206–208.

Frederick, I. et al. (2000). Incident type 2 diabetes mellitus in African-American and white adults. JAMA, 283(17), 2253–2259.

Goetzl, L. & Wilkins, I. (2002). Glyburide compared to insulin for the treatment of gestational diabetes mellitus: A cost analysis. Journal of Perinatology, 22(5), 403–406.

Kelly, B. et al. (2005). Controversies around gestational diabetes. Canadian Family Physician, 51(5), 688–695.

Kieffer, E. et al. (2001). Obesity and gestational diabetes among African-American women and Latinas in Detroit: Implications for disparities in women's health. Journal of the American Medical Women's Association, 56(4), 181–187.

NDEP (2010). The diabetes epidemic among African-Americans. National Diabetes Education Program. Retrieved from http://ndep.nih.gov/media/FS_AfricanAm.pdf

Osei, K., Gaillard, T. R., & Schuster, D. P. (1998). History of gestational diabetes leads to distinct metabolic alterations in nondiabetic African-American women with a parental history of type 2 diabetes. Diabetes Care, 21(8), 1250–1257.

Persson, M. et al. (2011). Mission impossible? Midwives' experiences counseling pregnant women with gestational diabetes mellitus. Patient Education and Counseling, 84(1), 78–83.

Qiu, C. et al. (2011). Gestational diabetes mellitus in relation to maternal dietary heme iron and nonheme iron intake. Diabetes Care, 34(7), 1564–1569.

Razee, H. et al. (2010). Beliefs, barriers, social support, and environmental influences related to diabetes risk behaviors among women with a history of gestational diabetes. Health Promotion Journal of Australia, 21(2), 130–137.

U.S. News Health (2011). Gestational diabetes. Retrieved from http://health.usnews.com/health-conditions/diabetes/gestational-diabetes