1. European Board and College of Obstetrics and Gynaecology
Global Challenges of Hyperglycaemia in Pregnancy and its Sequelae
Dr Tahir Mahmood CBE,
MD, FRCPI, MBA, FACOG, FRCPE,FRCOG
President EBCOG
19th May International session
Antalya, Turkey
Global Challenges

2. EPIDEMIOLOGY OF OBESITY
Australia % of women and 52% of men are obese (BMI >30)
(2.5 fold rise in obesity over the last 20 years)
USA Overall 61% population have a BMI >30
UK Overall >30 % population have a BMI >30
(Indian = 20%; Pakistani origin = 24%)
Mahmood TA. Obesity and Pregnancy. Br J Diab Vasc Dis.2009; 9(1):1-4
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3. Epidemic of Obesity Trebled in England from 1980s to 2000
In % of adults obese
A further 35% women and 46% of men overweight
14% of children between 2-10year obese
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6. Global Projections for the Diabetes Epidemic: 2007-2025 (millions)
Global Projections for the Diabetes Epidemic: (millions)
53.2
64.1
21%
28.3
40.5
43%
24.5
44.5
81%
46.5
80.3
73%
67.0
99.4
48%
16.2
32.7
102%
10.4
18.7
80%
Diabetes
2007 = 246 million
2025 = 380 million
Increase 55%
IGT
2007 = 309 million
2025 = 419 million
Increase 36%
IDF Atlas 2006
Global Challenges
Diabetes Atlas, 3rd edition, IDF 2006

7. Global Challenges

8. Undernutrition ~26 million
Select Maternal conditions that contribute to Foetal Programing
~130 million live births
Anaemia
~56 million
Undernutrition ~26 million
Obesity
~42 million
Hyperglycaemia
~ 21 million
Hypertension
~ 7 million
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9. Problems of Obesity in Women- Non Communicable Diseases
Type 2 diabetes
GDM during Pregnancy
high blood pressure
high cholesterol levels
coronary heart disease
congestive heart failure
angina pectoris
stroke
bladder control problems
asthma
osteoarthritis
musculoskeletal disorders
gallbladder disease
sleep apnea and respiratory problems
gout
Pelvic Floor Dysfunction
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10. Problems of Obesity in Women-NCDs
Increased Risk of Cancer
uterus
breast
kidney
liver
pancreas
esophagus
colon and rectum
Poor female Reproductive Health
Complications of pregnancy
menstrual irregularities
infertility (PCOS)
irregular ovulation
Contraception Issues
In a study involving 90,000 obese women, increased risk of death has been reported (JAMA, 2006)
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16. Hyperglycaemia During Pregnancy
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17. Types of hyperglycemia in pregnancy
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18. Intrauterine exposure to maternal hyperglycemia Fetal and neonatal complications in the short term
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19. GDM and Challenges for the European Obstetric practice
Comparison between countries is very difficult due to different diagnostic strategies for GDM and subpopulations
A contributing factor for the large variation in practices is probably the differing recommendations by international and local scientific organizations
Migrants, ethnic diversity and national health policies
This makes it very difficult to make comparisons between countries
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20. Post Partum Follow Up
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21. Type 2 diabetes after gestational diabetes – a systematic review and meta-analysis Bellamy, Lancet 2009; 373: 1773–79
The risk of type 2 diabetes after GDM has increased over the last 25 years (Lauenborg et al, Diab Care 2004)
GDM vs. normoglycemia during pregnancy RR 7.43 for subsequent type 2 diabetes within 10 Years: % CI 4.79–11.51
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22. Prevalence of the metabolic syndrome 10 years after GDM
Adj. OR 3.4
(95% CI )
N=481
N=1000
Lauenborg et al. JCEM 2005
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23. Intra-Uterine Environments , intra-Generational Obesity and Diabetes are inter-linked
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24. In Utero Exposure to Maternal Hyperglycemia Increases Childhood Cardiometabolic Risk in Offspring Diabetes Care 2017;40:679–686 | DOI: /dc
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25. Pre-Pregnancy Weight (>30 BMI) was associated with offspring behavioural problems such as Attention deficit (Incidence risk 3.3: 95%CI )
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26. EBCOG Response Two Prong Approach
Set up a European Wide group to develop EBCOG Position for GDM Screening
Publish Standards of Care for Obstetric Practice- including Care of Obese Women during Pregnancy
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27. EBCOG Response
Two Prong Approach
Set up a European Wide group to develop EBCOG Position for GDM Screening
Publish Standards of Care for Obstetric Practice- including Care of Obese Women during Pregnancy
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29. Global Challenges

30. Standards of Care for Women’s Health in Europe
EBCOG has developed Standards of Care for
Obstetrics and Neonatal Services
Gynaecology Services
STANDARDS OF CARE
The Standards of Care are intended to address variations and inequities in access to care.
They will lead to a clearer understanding about what standards of treatment and care patients can,and should, expect.
The Standards of Care focus on the safety, care, dignity and treatment of patients.
They reflect the Care that a Health Service and prudent Healthcare Professional should provide in order to be effective and safe for the patient.
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31. Standards of Care for Women’s Health in Europe
The following is the complete list of the STANDARDS for OBSTETRIC and NEONATAL SERVICES:
STANDARD 1 Generic Standards of Care for Maternity Services
STANDARD 2 Pre-Pregnancy Services
STANDARD 3 Early Pregnancy Emergency Services
STANDARD 4 Antenatal Care
STANDARD 5 Antenatal Screening
STANDARD 6 Care of Pregnant Women with Pre-existing Medical Conditions and/or
Special Needs
STANDARD 7 Care of Pregnant Women with Mental Health Conditions
STANDARD 8 Care of Women Developing Medical Conditions during Pregnancy
STANDARD 9 Care of Obese Pregnant Women
STANDARD 10 Prevention of Preterm Birth
STANDARD 11 Intrapartum Care
STANDARD 12 Infection Prevention and Control
STANDARD 13 Maternal Mortality and Morbidity associated with Childbearing
STANDARD 14 Post-natal Care of the Mother
STANDARD 15 Neonatal Care
STANDARD 16 Rationalising Care of Babies Born Prematurely
STANDARD 17 Supporting Families who Experience Pregnancy Loss
STANDARD 18 Routine Data Collection for Pregnancy and Childbirth
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32. Global Challenges

33. Standardised Antenatal care
Pre Pregnancy advice- awareness campaign
Higher dose of Folic Acid ( 5mg) in the peri-conceptual period
Smoking cessation
Early access to antenatal care for risk assessment
Access to protocol based antenatal care
Screening for congenital malformations
One Step GDM Screening
Monitoring foetal growth and wellbeing
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34. A Case for Universal one step GDM Screening
FIGO Initiative supported by EBCOG
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35. FIGO Box – Universal Testing
FIGO adopts and supports the
IADPSG / WHO / IDF/EBCOG
position that all pregnant women should be tested for hyperglycemia during pregnancy using a one-step procedure.
FIGO encourages all countries and its member associations to adapt and promote strategies to ensure universal testing of all pregnant women for hyperglycemia during pregnancy.
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36. FIGO Box – GDM management
FIGO recognizes that management of diabetes in pregnancy should be made in accord with available national resources and infrastructure, even without high quality evidence, as it is preferable to the alternative of no or poor care.
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37. Options for Diagnosis of GDM
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38. FIGO Box – Postpartum
FIGO supports the concept that the postpartum period in women with GDM provides an important platform to initiate early preventive health for both the mother and the child who are both at a heightened risk for future obesity, metabolic syndrome, diabetes, hypertension, and cardiovascular disorders.
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39. Key Messages Obesity is a serious risk for women’s health
It not only effects reproductive outcomes but also have long term effects on the quality of life, increased morbidity and risk of Pre mature mortality.
Every women during Pregnancy should be offered screening for HIP
There should be a robust policy of following up these women post natally for weight management.
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40. Thank You
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