Risk can be managed with healthy lifestyle changes, lead author of the study by the MUHC’s Research Institute says.
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Women who have gestational diabetes during a second pregnancy are at higher risk of developing Type 2 diabetes later on in life compared with those who have it only in their first, a new study by the Research Institute of the McGill University Health Centre shows.
The study — published in JAMA last week — also showed the risk was greatest among women who had the condition in subsequent pregnancies. The goal was to see how the risk of developing the disease post-pregnancy evolves from one pregnancy to the next, in order to arm women with the ability to reduce their risk.
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Dr. Kaberi Dasgupta, the senior author of the study and senior scientist in the metabolic disorders and complications program at the RI-MUHC, said it’s known that gestational diabetes — a temporary condition — is a “strong signal” a person could be at risk of developing the disease later on in life. But the team behind the research was curious to see how that risk changes depending on whether a woman had gestational diabetes only in her first pregnancy, only in her second, or in both.
“Not all those situations are the same,” said Dasgupta, whose research and clinical practice focus on diabetes and diabetes prevention. “I think it’s important, because we’re in this era of what we call personalized medicine, and it’s an opportunity to kind of learn about what our different risk factors are to figure out what our overall risk is and decide what we need to do, how urgently we need to act, what our personal situation is.”
The study involved analyzing provincial data from 431,980 women who had two deliveries between 1990 and 2012 and did not have diabetes before or between their pregnancies, to see if they had developed it by 2019.
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When compared with women who didn’t have gestational diabetes, those who had it only during their first pregnancy had more than four times the risk of developing it later, those who had it only in their second pregnancy had more than seven times the risk, and those who had it in both pregnancies had nearly 16 times the risk.
That translates to a 76 per cent higher risk among those who had the condition only in their second pregnancy compared with those who had it only in their first. Dasgupta said that could be because the stresses and life changes from the first pregnancy could make it difficult for women to maintain their health before the second one.
“They may not have been as active as they were before, they then got pregnant again and then they gained additional weight and then they developed gestational diabetes,” she said. “That possibly puts them, then, on a pathway that’s different than a woman who had it in the first pregnancy, was able to take action, didn’t get it in the second pregnancy. We can now confirm that she did lower her risk in the longer term.”
When it comes to reducing the risk, Dasgupta said that ultimately, “something is always better than nothing, and more is always better than less.”
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“If we’re physically active and if we are eating a healthy diet: fruits and vegetables, lean proteins, limiting very high-sat foods, highly refined foods, and also trying to come as close as we can to our optimal weight, which is a little different for everybody … then we’re going to reduce our risk,” she said. “It is harder when your kids are younger to kind of prioritize your health, but it is important.”
Women need support to be able to optimize their health while juggling work and motherhood, especially from their partners, Dasgupta said.
She added that it’s not always a matter of personal choice due to issues related to food security and income.
“We need to both as individuals try to make healthy choices, but we also, as societies, need to make it easier for moms to make healthier choices and to have access to the resources that they need to be able to do that, because it’s not always easy,” she said.
A release announcing the study’s findings notes one in 10 adult Canadians has Type 2 diabetes, “a disease that damages blood vessels and can lead to heart disease, stroke, kidney disease and even blindness.”
The baseline risk for developing certain conditions differs from person to person, Dasgupta noted, but maintaining as healthy a lifestyle as possible can greatly reduce risks in general.
“Diabetes has bad company: heart disease, stroke, high blood pressure,” she said. “That’s what we’re all trying to prevent. And we’re all struggling with that as a society, because it’s so easy to not move around. A lot of the stuff we do is online, there’s a lot of unhealthy options that are really tasty, and it’s tough when we’re stressed and we don’t have the finances to have the healthiest food and we kind of cut corners and wind up in a place where we’re at risk.
“So we have to be attentive to the wake-up calls, and gestational diabetes is one of them.”
kthomas@postmedia.com
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