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A foetus free from exposure to any of the maternal life style diseases, for example obesity and diabetes, is a key to reductions of the epidemic of diabetes in Qatar, opined a team of researchers at Sidra Medical and Research Centre. |
They pointed out that the best solution to reduce the increase of diabetes in the future is to provide the best environment for the mother and her foetus. This can reduce the risks of developing diabetes and cardiovascular diseases in the mother after delivery and gives a sound beginning for the newborn.
Lars Hedin, principal investigator and Ingrid Osmond, pregnancy registry manager, Division of Clinical Epidemiology, Sidra Medical and Research Centre, stated that research during the two last decades had shown that if the mother had diabetes that was not well controlled, it would increase the risk for the baby to develop obesity, diabetes, cardiovascular diseases and hypertension later in adult life.
Hedin commented that Qatar was one of the countries in the world with the highest prevalence of diabetes. “According to Qatar Diabetes Association Qatar, the prevalence of diabetes in the total population is 16.7%. In addition, there has been an increasing number of gestational diabetes cases.”
Gestational diabetes - a type of diabetes amongst women that is developed and discovered during pregnancy - is to be treated with greater attention and importance so that the foetus is not exposed to high levels of sugar and lipids that are a consequence of an untreated diabetic condition in the mother. If a woman with gestational diabetes is left without treatment, this will increase her risk to develop type 2 diabetes, later in life, and her offspring’s risk to get diabetes and cardiovascular diseases later in life.
Hedin said: “That’s why it is strongly recommended for all pregnant women to undergo an oral glucose tolerance test between week 24 and 28 of pregnancy. All pregnant women are supposed to undergo this test which is done by drinking 75 grams of a glucose solution in the morning after a night’s fast. Blood sugar is measured before and after the test. Based on the results of the blood sugar measurements you come to know if you are healthy or diabetic.”
They emphasised that women, pregnant or not, should follow a balanced diet and do regular physical activity, to prevent diabetes. “If these measures are not enough, some women need insulin treatment and now there is an alternative, metformin, which is a drug that is also commonly used for treating type 2 diabetes.
Osmond said that people previously believed that gestational diabetes was fully resolved after delivery. “But that´s no longer considered correct. Mothers who have had gestational diabetes will have a substantially increased risk to develop type 2 diabetes later in their lives. Therefore, it is important for the mother to have accurate diagnosis, treatment and follow up for gestational diabetes.”
According to the researchers, another important factor is breast feeding. Breast milk will reduce future obesity and risk of diabetes in the baby, and breast feeding will also help the mother to reduce her weight and decrease health risks associated with obesity. “You are less likely to get even type 1 diabetes if you are a breast-fed baby,” they emphasised.
Hedin pointed out that gestational diabetes could also cause complications for the foetus. “Some foetuses can be larger at birth and there can be complications during delivery. The earlier you diagnose it, the better, you will have more time to introduce efficient treatment and that is one of the focuses of our research.”
As for the reasons for developing diabetes during pregnancy, Osmond said: “Women will be more likely to develop diabetes during pregnancy if they are overweight prior to pregnancy or if they are older than 35. They are also at risk if their parents have diabetes and if they have had symptoms of diabetes during previous pregnancies. But what we do not know is what the exact incidence is in Qatar. We think it is high and studies from other countries suggest it is.”
She continued that their research will look into the reasons for the high prevalence of gestational diabetes. “We will look into many factors such as: Is it because the population here is more obese than in other countries, say for example Scandinavian countries? Is it because women have babies at an older age? Is there a genetic component? These are areas we want to investigate and at present we do not have the full answers.”
Hedin suggested that studies done so far had shown that there were some ethnic factors. “Women from South Asia are at higher risk of diabetes even if they have a normal BMI. A combination of fast food consumption, less physical activity and some genetic factors can be a reason.” Citing genetic and lifestyle factors, Hedin pointed out the example of a study on gestational diabetes in Sweden where it was found that it was more prevalent among the large immigrant Arab population.
“Studies in animals have also revealed that if the mother has a high fat or high calorie diet it will affect the development of the pancreas in the foetus. Too little food as well as too much food for the mother will affect the foetus.”
He said “if a mother had gestational diabetes in her first pregnancy, in all likelihood she will develop the same in the next pregnancy. But if she loses some weight, controls her diet and engages in more physical activity, she can prevent getting gestational diabetes. Healthy living habits can reduce the risk of getting diabetes both gestational and type 2 diabetes.”
The researchers also pointed out that abdominal fat was a deciding factor in diabetes “We are going to investigate this theory further. Diabetes and obesity are closely connected and along with elevated blood pressure it can lead to miscarriages, preterm birth and other complications.” They commented that in addition to Qataris, the people from the Indian subcontinent were also more vulnerable to diabetes in Qatar.