Diabetes in the Hispanic Women during pregnancy in the LOS ANGELES - Research Paper Example

? Diabetes in the Hispanic Women during pregnancy in Los Angeles Introduction Diabetes has become one of the major diseases. As all of us know that this disease is a condition, in which the body suffers from the shortage of insulin or the body has a decreased ability to use insulin. After consuming the food, the stomach and intestines play a crucial role in digesting the carbohydrates from the food we consume to a sugar called glucose, which is the main source of energy for our body. After the process of digestion, glucose moves into the blood and, thus, the body can accumulate energy. The pancreas has a very important role in the digestive system. It produces a hormone that breaks down glucose and removes it from our blood and into the cells of the body. If the person is diabetic, two possibilities can take place. Either our body is not able to produce enough insulin or our cells cannot use the insulin the way they should. Consequently, the glucose builds up in the blood and the person gets diabetes or high blood sugar. There are three major types of diabetes: Type1 Diabetes: This diabetes is also known as insulin-dependent, immune mediated or juvenile-onset diabetes Type 2 Diabetes: This diabetes is also known as non-insulin dependent diabetes or adult onset diabetes Gestational Diabetes (GDM) Gestational diabetes occurs in women during pregnancy. In our paper, the focus is on Gestational Diabetes. The scope of the study is Diabetes in Hispanic women during pregnancy. Gestational diabetes, which is also known as Gestational Diabetes Mellitus, is a disorder. Gestational diabetes takes place during pregnancy. If a woman has no previous record of diabetes, and if she gets diabetes during her pregnancy, then she has gestational diabetes. It is necessary to know about the disorder called diabetes. Gestational diabetes happens in about 5 percent of all pregnancies, or about 200,000 cases a year in the United States. (Shriver) Key words: Gestational diabetes, Hispanic women. Statement of the problem: The prevalence of diabetes is at least 2–4 times higher among black, Hispanic, American Indian, and Asian/Pacific Islander women than among white women (Beckles & Thompson). Gestational diabetes develops during pregnancy. The Ethnicity plays a crucial role in the development of gestational diabetes. In the research paper, the focus is on the problem of gestational diabetes among the Hispanic women. As mentioned below the Hispanic women are more prone to the diabetes during pregnancy. The significance of the study: For a long period of around a century, diabetes during pregnancy has a severe and adverse effect on foetal neonatal outcomes. The paper takes into consideration a particular community, i.e. Hispanic community for study. It is because as mentioned above the chances of detecting diabetes among Hispanic women is substantial. Figure 1 The second reason is that Hispanics have been the largest minority population (26%) in the United States (see the chart below) As far as California is concerned 47% of the population in California, Los Angeles is Hispanic and California has been the home for around 18 million Hispanics. They have been barriers as far as health care is concerned. Figure 2 The number of Hispanic women, which are diabetic, is alarming. The largest minority women are still facing health problems in the most developed country of the world. This is the reason why the study of Hispanic women’s gestational diabetes has become crucial. Figure 3 Gestational diabetes further leads to heart diseases among the women. Hispanic women with gestational diabetes developed heart disease to a greater degree than predicted. Bentley-Lewis said that more research is needed to learn why. Below is the report that shows the rate of gestational diabetes among the women of all races in California. In 2003, the rate of gestational diabetes is highest among the Hispanic women. We can see that except in the year 1995, there is a constant and steady growth among the rate of gestational diabetes among Hispanic women. Figure 4 The rate of gestional diabetes among all women by race and ethnicity in Los Angeles, California. The data is between 1991 and 2003, which was highest in 2002 and 2003. It is given in tabular form below. Figure 5 The causes of gestational diabetes among Hispanic Women: While describing the causes of gestational diabetes Stuart Wiess, an associate clinical professor at New York University of Medicines’ Langone Medical Research Centre in New York City says, “pregnancy is an insulin-resistant state where your response to insulin decreases.” (Berlin) The researchers have found that the Hispanic women who have a history of gestational diabetes are 70% more likely to develop heart disease than their Hispanic counterparts who have never had pregnancy related diabetes. The paper tries to find out whether there is any association of race ethnicity with gestational diabetes, if the association is there, then to what extend and what might be the various causes behind the ethnic association of diabetes. Diabetes is the main clinical as well as physical challenge especially concerning the special ethnic group, the major cause of diabetes among Hispanic women during pregnancy is obesity and physical inactivity. “Overweight and obesity are major contributors to many preventable causes of death. On average, higher body weights are associated with higher death rates. Those who are overweight or obese have a substantially higher risk of developing high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and breathing problems, and certain types of cancer. (US DHHS, 2000). The major consequence of the gestational diabetes is that it results in the development of type 2 diabetes, in mother as well as the child, which is very serious matter. Gestational diabetes also results in the frequent follow up visits, home monitoring, other pregnancy complications etc. There are some major factors that cause gestational diabetes in Hispanic women. Among them include family history, individual history, obesity and increased weight gain during pregnancy. Among these causes, some of them such as family history and individual history are beyond human control. However, the other factors such as obesity or increased weight can be controlled with proper diet and exercise. As the rate of having diabetes among Hispanic women is higher, it suggests that this group or community of women are in requirement of a special attention to prevent from gestational diabetes. Hispanic culture in America has its special status and identity in American society. They have their unique cultural beliefs. It has been important to know their food habits and according changes them towards western medicines. The main reason is that most of the Hispanic women have non-medical explanations for diseases. It is important to develop the awareness of proper and nutritious diet. As far as the knowledge of nutritious diet is concerned, they have low level of education; consequently they do not read food labels Proper education needs to be imparted to these women about gestational diabetes. Along with unawareness about western medication, the behavioural problem also is there which makes them neglect their health problems. The Hispanic women are likely to consider the needs of their family before their own needs. They give priority to their family and the health of their family members and neglect their own health. It is because according to their cultural norms, attentiveness towards self-health is regarded as being self-indulgent. The primary role of the women is to look after her family first. Even if she becomes aware of her diet, in such circumstances it becomes difficult for her to execute the suggestions of the physician in practice. The women cannot change the food habit just for her excluding all other family members. Another important factor is the trust. If the trust on the physician is lacking then the impact of his or her advice will be less on their behaviour. It is generally found in Hispanic community that they have no trust on their doctor and hence they do not comply with prenatal vitamins, medications, appointment schedule etc. Language barrier is also the important agent in prevailing gestational diabetes among Hispanic women. The Hispanic women do not understand English and so they are not comfortable while seeking medical treatment. They also are not aware of the medical system in their country. The language also becomes an obstacle in the diagnosis and treatment of gestational diabetes. The agents of Gestational Diabetes: The major agents of Gestational Diabetes are as follows: Oral Antidiabetic Agents Insulin Insulin resistance and decreased insulin secretion characterize gestational diabetes. Therefore, insulin has become the standard treatment for gestational diabetes. A treatment with oral hypoglycaemic agents is the potential interest. Though it has still been the subject of controversy, this can be the sensible alternative to insulin therapy. It is because of its easy administration and patients’ satisfaction for non-invasive treatment. Sulfonylureas are currently the only drugs to be studied in GDM women in randomized controlled trials. (Guido Menato, Simona Bo, Anna Signorile, Marie-Laure Gallo, Ilenia Cotrino, Chiara Botto Poala, Marco Massobrio) A recent study conducted by a large managed care organization on more than 500 patients found that glyburide can be used as an alternative option to insulin in achieving glycemic control and adequate birth weights in offspring of women who failed with diet. It has been proved as effective as insulin. (Jacobson, Ramos, Ching et al. 2005) Well-designed and thorough studies have reached the conclusion that there is no association between oral hypoglycaemic agents and congenital malformation. Oral hypoglycemic agents, such as glyburide and metformin, are safe to use in pregnancy with maternal and perinatal outcomes similar to insulin treatment, but there is a need for a randomized controlled trial in women with Type 2 diabetes and GDM in pregnancy with long-term follow up of both mothers and children. (Hawthorne 2006) It is effective when diet fails to optimize the glycaemic profile during gestational diabetes.” Condition Gestational diabetes occurs due to the phenomenon which obstructs insulin. It means that even though the pregnant woman’s body can make insulin, it is lousier insulin and does not react to receptors at the cellular level. If the woman is overweight, the condition becomes worse. During pregnancy if the insulin cannot do the job anymore, the condition is called Gestational Diabetes Mellitus. The insulin in such cases is not so powerful. There is a circle of system that starts from the diet. A diet with low sugar and carbohydrates contains low sugar. The less sugar in the system results in less left over from the faulty insulin chemistry. This is called diet-controlled gestational diabetes. Most of the women with gestational diabetes require insulin injections. The women with gestational diabetes later on suffer from regular diabetes. They tend to have large babies. Therefore, a proper diet is the only way to control the diabetes. The pregnant woman is at a high risk for gestational diabetes if she: Is obese Has given birth to a heavy weight baby (9 pounds or more). Such babies are known as macrosomic. Has suffered from gestational diabetes in her previous pregnancy Has a strong family history of diabetes. Morbidity and Mortality in gestational diabetes Diabetes, both chronic and gestational (developing only during pregnancy), may pose health risks to a woman and her baby. Women with gestational diabetes are at an increased risk of developing diabetes later in life. (Centers for Disease Control and Prevention, Diabetes in Pregnancy) The major cause of the maternal as well as child morbidity and mortality is gestational diabetes. The risks, which are associated with gestational diabetes, are mentioned in a following tabular form. Figure 6 Diabetes during pregnancy results into a high risk of perinatal morbidity and mortality. One of the major complications as mentioned above is the high weight baby syndrome. This is also known as macrosomia, which causes shoulder dystocia and other birth injuries to the child as well as the mother. Figure 7 But it is not always applicable that macrosomic babies are the consequence of gestational diabetes. The study conducted by Nickel et al. According to his study he found that 60% of women giving birth to macrosomic babies developed diabetes later in life. This means that six out of ten mothers may have had gestational diabetes or hyperglycemia during pregnancy, but they were never diagnosed. (Nickel, Hagacad & Wease 1966) Conclusion and Recommendation: Hispanic women are more prone to gestational diabetes as compare to the Non-Hispanic white women. There are many factors involved in prevalence of gestational diabetes among Hispanic women, which include cultural, physical and geographical problems. The awareness towards self-health should be developed among these women. Proper care should be taken and they should give priority to their health first. The health of the offspring depends upon the health of the mother. Hence, proper education should be given to grow awareness among them regarding diabetes. It is necessary for them to pay attention to their diet, as well as to keep themselves in touch with the main stream of America. A health awareness program needs to be conducted. As far as physical health is concerned, the following recommendation has been given to them: 1. They need to make a pregnancy plan. The interaction with the doctor is very essential. With the help of the doctor, they will be able to prepare themselves physically and mentally. 2. Keeping weight in control is also very important. Periodically they have to get informed about the blood sugar level. 3. Along with the doctor, they have to consult with the dietician for seeking nutritional counselling. The dietician will give such a healthy diet plan which will facilitate keeping blood sugar at an optimum level and will assure the proper supply of food to the baby 4. The body weight is also a major factor. For that they need to consult the doctor to know how much their ideal weight should be during pregnancy. With a proper diet and exercise, they can maintain their body weight. 5. Lastly, they should give priority to their health and remove from their minds the false conception that priority to self-health is self-indulgence and selfishness. ---------------------------------------------------------------------------------------------------------------- References Beckles, G. L.A. & Thompson, P. E. Reid US Department of Health and Human Services, Centre for Disease and Prevention. Retrieved from: http://www.cdc.gov/diabetes/pubs/pdf/women.pdf Berlin, E. M. D. Gestational Diabetes and Ethnicity. Retrieved from: http://www.everydayhealth.com/gestational-diabetes/gestational-diabetes-ethnicity.aspx Hawthorne, G. (2006). Metformin use and diabetic pregnancy- has its time come? Diabetic Med. 23, 223-227. Jacobson, G.F., Ramos, G.A., Ching, J.Y. et al. (2005).Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am. J. Obstet. Gynecol. P.193, 118-124. Menato, G., Bo, S., Signorile, A., Gallo, M.-L., Cotrino, I., Chiara Botto Poala & Massobrio, M. Current Management of Gestational Diabetes Mellitus: Oral Antidiabetic Agents, Authors and Disclosures. Expert Commentary: Recommendation of Existing & New Clinical Strategies. Retrieved http://www.medscape.com/viewarticle/568728_4 Nickel, I., Hagacad, W.P. & Wease, W.H. (1966). Glucose tolerance and excessively large infant. A twelve year follow-up study. Am J Obstet Gynecol 94:62. Shriver, E. K. (April 29, 2008). Gestational Diabetes, National Institute of Health, National Institute of Child Health and Human Development. Retrieved from: http://www.nichd.nih.gov/health/topics/gestational_diabetes.cfm FIGURES: Figure 1 Retrieved from: http://www.yolocounty.org/Index.aspx?page=321 Figure 2. Retrieved from: http://www.city-data.com/city/Los-Angeles-California.html Figure 3. Retrieved from: Population Reference Bureau 2011. Figure 4. Age Adjusted Rates of Gestational Diabetes Among All Women and by Race/Ethnicity – Los Angeles Country, California, 1991 – 2003. Figure 5. Gestational diabetes causes risks to both child (foetal risks) and mother (maternal risks). Retrieved from:http://www.worlddiabetesfoundation.org/composite-2671.htm Figure 6. Reprinted from Pridjian, G. & Benjamin, T.D. Update on gestational diabetes. Obstet Gynecol Clin North Am. 2010;37(2):255-267. Read More