An international team of researchers led by Western Sydney University have published a new Lancet Series challenging current approaches to managing Gestational Diabetes Mellitus (GDM) and initiating earlier treatment to prevent complications during pregnancy and beyond.
Published by The Lancet today, the authors of the new Series are calling for the urgent introduction of strategies to prevent and manage GDM throughout a woman's life, including earlier testing and diagnosis to reduce pregnancy and delivery complications and decrease the risk of developing other health conditions later in life.
Lead author of the series, Distinguished Professor David Simmons from the University's School of Medicine and Translational Health Research Institute, said that GDM cases are increasing globally and becoming more complex due to higher levels of risk factors such as obesity.
"Our new Seriesemphasises the urgent need for a major shift in how gestational diabetes is first diagnosed and managed, not only during pregnancy but throughout the lifetime of mothers and their babies.
"Gestational diabetes is an increasingly complex condition, and there isn't a one-size-fits-all approach to managing it. Instead, a patient's unique risk factors and metabolic profile should be considered to help guide them through pregnancy and support them afterward to achieve the best health outcomes for women and babies everywhere," said Distinguished Professor Simmons.
As the most common medical pregnancy complication worldwide, GDM affects one in seven pregnancies (14 per cent).
Without treatment, gestational diabetes can lead to high blood pressure, increased risk of Caesarean sections, mental health conditions, and complications for the baby at delivery, alongside health complications for the mother later in life, such as type 2 diabetes and cardiovascular disease.
Recent evidence suggests that the foundations for developing GDM occur before pregnancy, with metabolic changes often detectable in early pregnancy before 14 weeks. However, GDM is typically only tested for and treated late into the second or third trimester of pregnancy (24-28 weeks).
Distinguished Professor Simmons says a better understanding of GDM and its effects can help researchers, clinicians, and policymakers develop new management approaches that focus on improved prevention and treatment of GDM complications from pre-conception, through to pregnancy and beyond.
"It is past time to move from 'late pregnancy' focused services to an integrated, personalised life-course strategy across both high and low-resource settings.
"This includes new, systematic approaches to prevention, early GDM treatment, identifying and overcoming barriers to uptake, better health system integration, and more research to better understand how GDM affects women and their children during pregnancy and throughout their lives."
The recommended strategies developed by Distinguished Professor Simmons and co-authors of the new Lancet Series include:
- Early GDM testing of those with risk factors, ideally before 14 weeks gestation.
- Promoting health at the population level that prepares women, especially those with risk factors for a healthy pregnancy and, after that, for healthy aging.
- Improved antenatal care that includes postpartum screening for glycaemic status.
- Tailored annual assessments in women with prior GDM to prevent or better manage complications such as type 2 diabetes (particularly in subsequent pregnancies) and cardiovascular disease.
- More research into GDM and how to improve outcomes of women with GDM and their children across the life course.
Distinguished Professor Simmons and co-authors will be speaking at the American Diabetes Association 84th Scientific Sessions conference running 21-24 June 2024 in Orlando, Florida, USA.
The new Lancet Series 'Managing gestational diabetes much earlier in pregnancy can prevent complications and improve long-term health outcomes, experts say' can be viewed here .
