Kaiser study: Diabetes risk rises for pregnant women

Sharp increase in obesity to blame, researchers say

By Bill Scanlon, Rocky Mountain News (Contact)

Published April 28, 2008 at midnight

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American women are twice as likely to be diabetic during pregnancy as they were just six years previously, and the reason seems to be the huge increase in obesity, a new study by Kaiser-Permanente suggests.

Obesity among pregnant Colorado women has risen sharply over the past dozen years, even though the state still has one of the lowest overall obesity rates, said Dr. Joyce Gottesfeld, an obstetrics gynecologist with Kaiser in Denver.

Obesity is the leading indicator of Type II diabetes, which long ago surpassed Type I (or childhood) diabetes as the major type of diabetes.

The study of 175,000 women who gave birth at 11 Kaiser facilities between 1999 and 2005 is the largest to look at trends in diabetes and pregnancy, Kaiser officials say.

Other studies have looked at so-called gestational diabetes that hits women during pregnancy but usually disappears shortly after the baby is born.

The new study found a five- fold increase in diabetes during pregnancy among teen mothers.

"Whenever we see a woman in her child-bearing years, which teens, unfortunately, definitely are, we do pre-conception counseling," Gottesfeld said. "Weight management absolutely is part of that."

In fact, Kaiser's pediatricians are on board, advising girls and teens of the importance of avoiding obesity so upcoming pregnancies won't be at risk.

Obese women are more likely to miscarry, have stillbirths or give birth to babies with problems, Gottesfeld said.

And the babies themselves are more likely to be born overweight, have trouble with blood sugar and require intravenous deliveries of glucose.

It's easy enough to advise people to eat better, but it can be difficult to actually change behavior, Gottesfeld said.

She noted that there are weight-management programs available and yet, "it's a tough battle."

"It's still ultimately up to the patient to do the hard work," she said.

Gottesfeld said that, unfortunately, it's the bad food that is the least expensive and therefore most attractive to people on limited budgets.

"Junk food is more affordable than raspberries or strawberries," she said. "I don't see how a family earning, say $50,000 a year, can afford" to keep a steady supply of fresh fruits and vegetables in the house.

African-American, Hispanic, and Asian or Pacific Islander women were more likely to have diabetes before pregnancy than white women in the study.

"More young women are entering their reproductive years with diabetes, in part due to the fact that our society has become more overweight and obese," said lead author Jean M. Lawrence, a Kaiser research scientist.

"The steps to reducing risk of Type II diabetes must start before childbearing years: healthy eating, active living and maintaining a healthy weight," she wrote. "These habits should begin in childhood and continue through adulthood."

The authors hope that being presented with the health risks of having diabetes during pregnancy can spur young women toward a healthier lifestyle.

"My advice to women who have Type I or Type II diabetes and are thinking about becoming pregnant is: Work with your health care professional to get your blood sugar in good control," Lawrence said.

"If you are prediabetic or have Type II diabetes and are overweight, work on reducing your weight by a few pounds before becoming pregnant."

scanlon@RockyMountainNews.com or 303-954-2897

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