Impact of Gestational Diabetes Mellitus in Pregnant Hispanic Women

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08/02/20 Medical Reference this

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Diabetes has been one of the top three death causes among Hispanics according to World Health Organization (WHO). Due to the lack of poor nutrition and physical activity, Hispanics are suffering from type 2 and type 2 diabetes. According to the article, Projecting diabetes prevalence among Mexicans aged 50 years and older: the Future Elderly Model-Mexico (FEM-Mexico) by Cesar Gonzalez-Gonzalez, Bryan Tysinger, Dana P. Goldman and Rebeca Wong, diabetes is continuously growing as a major health problem and a tremendous burden on the population. Nonetheless, although men, women, and children all together are suffering from this health issue, pregnant women are being impacted the most. Gestational Diabetes Mellitus (GDM) is a condition of any degree of glucose intolerance where it is first recognized during pregnancy and it is a common complication. Huerta-Chagoya, Vázquez-Cárdenas, Moreno-Macías, Tapia-Maruri, Rodríguez-Guillén, López-Vite, García-Escalante, Escobedo-Aguirre, Parra-Covarrubias, Cordero-Brieño, Manzo-Carillo, Zacarías-Castillo, Vargas-García, Aguilar-Salina, and Tusié-Luna (2015) state that previous reports indicate that GDM is a strong risk factor for developing type 2 diabetes (T2D) later in life, and most importantly, it also influences the metabolic health of their offspring in the short and long term as well. Nevertheless, due to lack of exercise, poor nutrition, and an unbalanced weight woman can be at risk to get GDM during their pregnancy

Research Question

Diabetes is affecting Hispanic women in various ways. Pregnant women suffer from GDM and unfortunately it can end up affecting the child as well. Reyes-Muñoz, Castellanos-Barroso, Ramírez-Eugenio, Ortega-González, Parra, Castillo-Mora, & De La Jara-Díaz (2012) state that pregnant Mexican women with a history of infertility and polycystic ovary syndrome (PCOS) are at increased risk for developing GDM. This risk should be taken into consideration beginning early in the second trimester for a timely and safe intervention as well as to improve the maternal–fetal prognostic. Women of ethnic minority groups, especially Hispanic and Asian, have consistently been found to have an increased risk of GDM compared to non-Hispanic white women.

Etiology Risk factors

In a recent state-wide study by Carolan-Olah, Duarte-Gardea, Lechuga, and Salinas- Lopez (2017) conducted in the U.S., discussed the rates of GDM among Hispanic women and it were reported at 12.1%, compared to 6.8% among non-Hispanic white women. This increase has important consequences as Hispanics are the largest minority group in the U.S. Women with GDM are not the only ones who suffer during and/or after the pregnancy, the baby suffers as well. In Impact of Risk Factors for Gestational Diabetes (GDM) on Pregnancy Outcomes in Women with GDM, Filardi, Tavaglione, Stasio, Fazio, Lenzi, and Morano discussed a few risk factors that a baby can face such as: excessive birth weight, early birth and respiratory distress syndrome, low blood sugar, also known as hypoglycemia, and T2D diabetes. In regards to the excessive birth weight the extra glucose in a women’s bloodstream crosses the placenta, which triggers the baby’s pancreas to make extra insulin. This causes the baby to grow too big. Very large babies (those that weigh 9 pounds or more) are more likely to become forced in the birth canal, sustain birth injuries or require a C-section birth. Early birth and respiratory distress syndrome happens when the mother’s high blood sugar increases the risk of early labor and delivering the baby before the due date; yet the doctor may recommend early delivery because the baby is large. Babies born early may experience respiratory distress syndrome, which is a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. However, babies of mothers with GDM may experience respiratory distress syndrome even if they’re not born early. In addition, often times babies develop low blood sugar shortly after birth because their own insulin production is high. This may provoke seizures in the baby. Lastly, babies of mothers who have GDM have a higher risk of developing obesity and type 2 diabetes later on in their life. On the other hand, the mother can suffer from high blood pressure, preeclampsia and future diabetes. Ramos-Levi, Pérez-Ferre, Fernández, Del Valle, Bordiu, Bedia, Herraiz, Torrejón, and Calle-Pascual (2012) discuss the risks of GDM in women, which consist of the risk of high blood pressure along with preeclampsia, which is a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both the mother and the baby. If a woman has gestational diabetes, they are more likely to get it again during a future pregnancy. They are also more likely to develop type 2 diabetes as they get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes. Of those women with a history of GDM who reach their ideal body weight after delivery, less than one in four women eventually develop type 2 diabetes. Nonetheless, these risk factors can be prevented, to a certain extent, depending on the life style the mother choices to take.

Behavioral health theory

The behavioral health theory that was found most relevant to this topic was Theory of Planned Behavior (TPB) in a study conducted by Downs and Ulbrecht (2006). The attitude was exercising would benefit women with GDB. The subjective norm would be family members/spouse would approve of exercising for a healthy pregnancy. The perceived behavioral control was women exercising for a healthier pregnancy and avoid the fatigue. The behavioral intention was starting an exercising habit. Lastly, the behavior was exercising. To reduce the risk of T2D in women with GDM and GDM in general, there must be an increase in exercise. Through social influences, effective diabetes treatment and prevention programs women can avoid GDM. Maternal metabolic control during their pregnancy may prevent type 2 diabetes and the risk of obesity along with type 2 diabetes in their kids, which it would prevent them from GDM in general (Downs et al. 2006).

Interventions and results

Unfortunately, there are no guarantees when it comes to preventing gestational diabetes. However, the more healthy habits a pregnant woman can adopt before pregnancy, the better and the less of a risk the mom and baby will face. Eating healthy foods can help the mother carry a safer pregnancy. For example, Choosing foods high in fiber and low in fat and calories, focusing on fruits, vegetables and whole grain items would be an ideal diet. Radesky, Oken, Rifas-Shiman, Kleinman, Rich-Edwards, and Gillman (2008) state that in prior studies, diets high in total fat, saturated fat, red and processed meats, and with high glucose load increase the risk of developing GDM. Therefore, the group of women who had a healthier diet resulted with less women with GDM versus women from the other group who consumed the unhealthier eating habits. In Mexican households, for example, their eating habits are not the healthiest. The traditional dishes consist of deep fried items, and foods that require an excessive amount of oil. Among Mexican descendants, there has been lower consumption of their healthy traditional Mexican foods, which include fruit, vegetables, legumes, and whole grains (Santiago-Torres, Kratz, Lampe, Tapsoba, Breymeyer, Levy, Villaseñor, Wang, Song, Neuhouser, 2015).

 They don’t consist of healthy items such as vegetables and/or fruits, which is why Diabetes, in general, is the third causing death among Hispanics (WHO). Physical activity is also necessary. Bacardí-Gascón, Rosales-GarayJiménez-Cruz (2004) stated that Exercising before and during pregnancy can help protect women from developing GDM. Aiming for 30 minutes of moderate activity on most days of the week, take a brisk daily walk, riding your bike, and swimming laps could help prevent GDM. Bacardí-Gascón et al. (2004) conducted a study that was performed in Tijuana, Mexico. It consisted of women from seven diabetes education groups from three different Mexican institutions. Age range was from age 12 to 53. Sadly, 40% of the women were overweight and 31% were classified as obese. The population from this study has a low socioeconomic status, which usually confronts major environmental or economic barriers that prevent access to safe recreational areas or fitness facilities. It is recommended that individuals get at least a single 30-minute workout into their day. Physical activity is an emerging factor whose influence in GDM has been evaluated. Previous data have described that this is one of the strongest predictors contributing to the inverse association to GDM. The results of a recent systematic review demonstrated that the greater physical activity before or during early pregnancy is significantly associated with lower risk of GDM, with the magnitude of the association being stronger for pre-pregnancy physical activity. The less exercise women practiced prior to pregnancy, the more likely they were to develop GDM, and vice versa, the more exercise, the less likely the diagnosis of GDM. Doctors don’t recommend weight loss during pregnancy. But it is recommended that women lose weight prior to pregnancy, if necessary (Ramos-Leví et al. 2012). Nevertheless, educational programs would benefit Hispanic women educate themselves on how to carry with a healthy pregnancy. If they had the necessary information on how to eat healthier, how to exercise adequately, and how to maintain a balanced weight then not only GDM rates would lower, diabetes rates in general would minimize.

Conclusion

Gestational Diabetes Mellitus is a condition that has been affecting women throughout

the years. Unfortunately, minority ethnicities such as Hispanics get affected the most due to poor health choices. The lack of exercise, poor nutrition, and unbalanced weight leads them to suffer from GDM and it ends up affecting the kid and the mother. Seeing that the rates for non-Hispanic women are lower, it comes to show that they have a healthier pregnancy. Nonetheless, if Hispanic women were better informed about how to properly take care of themselves prior and during their pregnancy then the rates would be lower.

References

  • Alicia Huerta-Chagoya, Paola Vázquez-Cárdenas, Hortensia Moreno-Macías, Leonardo Tapia-Maruri, Rosario Rodríguez-Guillén, Erika López-Vite, . . . Teresa Tusié-Luna. (2015). Genetic determinants for gestational diabetes mellitus and related metabolic traits in Mexican women. PLoS ONE, 10(5), E0126408.
  • Bacardi-Gascon, M., Rosales-Garay, P., & Jimenez-Cruz, A. (2004). Effect of Diabetes Intervention Programs on Physical Activity Among Migrant Mexican Women With Type 2 Diabetes. Diabetes Care, 27(2), 616.
  • Carolan-Olah, Duarte-Gardea, Lechuga, & Salinas-Lopez. (2017). The experience of gestational diabetes mellitus (GDM) among Hispanic women in a U.S. border region. Sexual & Reproductive Healthcare,12, 16-23.
  • Downs, D., & Ulbrecht, J. (2006). Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus. Diabetes Care, 29(2), 236-23640.
  • Filardi, T., F. Tavaglione, M. Stasio, V. Fazio, A. Lenzi, and S. Morano. “Impact of Risk Factors for Gestational Diabetes (GDM) on Pregnancy Outcomes in Women with GDM.” Journal of Endocrinological Investigation 41, no. 6 (2018): 671-76.
  • Gonzalez-Gonzalez, C., Tysinger, B., Goldman, D. P., & Wong, R. (2017). Projecting diabetes prevalence among Mexicans aged 50 years and older: the Future Elderly Model-Mexico (FEM-Mexico). BMJ open7(10), e017330. doi:10.1136/bmjopen-2017-017330.
  • Radesky, J. S., Oken, E., Rifas-Shiman, S. L., Kleinman, K. P., Rich-Edwards, J. W., & Gillman, M. W. (2008). Diet during early pregnancy and development of gestational diabetes. Paediatric and perinatal epidemiology22(1), 47–59. doi:10.1111/j.1365-3016.2007.00899.
  • Ramos-Leví, A. M., Pérez-Ferre, N., Fernández, M. D., Del Valle, L., Bordiu, E., Bedia, A. R.,               … Calle-Pascual, A. L. (2012). Risk factors for gestational diabetes mellitus in a large population of women living in Spain: implications for preventative strategies.               International journal of endocrinology2012, 312529. doi:10.1155/2012/312529.
  • Reyes-Muñoz, Castellanos-Barroso, Ramírez-Eugenio, Ortega-González, Parra, Castillo-Mora, & De La Jara-Díaz. (2012). The risk of gestational diabetes mellitus among Mexican women with a history of infertility and polycystic ovary syndrome. Fertility and Sterility,97(6), 1467-1471.
  • Santiago-Torres, M., Kratz, M., Lampe, J. W., Tapsoba, J., Breymeyer, K. L., Levy, L., … Neuhouser, M. L. (2015). Metabolic responses to a traditional Mexican diet compared with a commonly consumed US diet in women of Mexican descent: a randomized               crossover feeding trial. The American journal of clinical nutrition103(2), 366–374. doi:10.3945/ajcn.115.119016
  • W. (2016). Mexico. Retrieved April 23, 2019, from https://www.who.int/diabetes/country-profiles/mex_en.pdf?ua=1
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