Juniper Publishers: Early Life Opportunities for Diabetes Prevention in China
JUNIPER PUBLISHERS- JOURNAL OF GYNECOLOGY AND WOMEN’S
HEALTH
Journal of Gynecology and Women’s Health-Juniper
Publishers
Authored by Huixia Yang*
Maternal hyperglycemia brings health issues for both
mothers and offspring. Offspring exposed to intrauterine hyperglycemia
have a higher birth weight and are prone to develop type 2 diabetes in
adult life. The concept of ‘DOHaD’ (Developmental Origins of Health and
Disease) emphasizes the importance of intrauterine environmental
exposures and brings new insights into the pathogenesis and progression
of diabetes. Thus, hyperglycemia management is meaningful for type 2
diabetes prevention in next generation.
In China, the problem of the primary and secondary prevention of diabetes is lacking [1]. We would like to emphasize that pregnancy could provide a critical window for prevention of type 2 diabetes in China [2].
Women who had gestational diabetes mellitus (GDM) have at least a
seven-fold increased risk of developing type 2 diabetes compared with
those who had a normoglycemic pregnancy [3]. Thus, GDM management could prevent diabetes in the early stage.
China is a country with an estimated 16 million
births per year, and the increasing prevalence of GDM has become a huge
burden. According to our study [4],
about one in five pregnant women had GDM in 2013 in China. Controlling
GDM will be even more challenging after the implementation of two-child
policy, as more and more women with advanced maternal age are trying to
conceive their second child. Although we have achieved a lot of progress
in GDM management in the past few years, such as setting up the uniform
diagnostic criteria for GDM, promoting public education via one-day GDM
clinic model and launching health workers training programmes [2],
there are several issues concerning GDM management. Firstly, there is
still lacking long-term follow-up programmes for GDM women and their
infants. Secondly, GDM management is rather difficult in areas with
low-resource settings. Thirdly, more studies are needed to evaluate
effects of different intervention strategies in the setting of China
such as exercise.
To further improve the GDM health care and prevention
in China, integrated care is indispensible. Now together with general
practitioners, we are establishing integrated care system for diabetic
women before, during and after pregnancy to improve outcomes. In
addition, obstetricians can and should play a key role in identifying
high-risk pregnant women and delivering evidence-based intervention such
as medical nutritional therapy and physical activity, and raise the GDM
awareness in the public. Relative simplified GDM diagnostic protocols
should be applied in rural or low-resource settings. Above all,
effective GDM management in China will not just beneficial for pregnant
women, but also prevent diabetes for the future generations of China.
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