1. DIABETES AND PREGNANCY IN WOMEN FROM DEVELOPING COUNTRIES LIVING IN ITALY Lorella Battini, Master on Bioethics and Education GENERAL COORDINATOR OF OGASH INSTITUTIONS AND HOSPITALS; CONTINENTAL (EUROPE) CHAIRMAN OF OGASH; Prize-winner of Prof. Ioseb Jordania International Prize-2008 Prize-winner of HERA’s GOLDEN PRIZE 2006 First Level Medical Manager at Obstetrics-Gynaecology Unit II-AOUP (Incaricated Chief : Dr. P. Bottone, Senior Consultant: Prof. V. Facchini)‏ OBSTETRICS – GYNECOLOGY INTEGRATEDDEPARTMENT OBSTETRICS – GYNECOLOGY INTEGRATED DEPARTMENT PISAHOSPITAL - UNIVERSITY SANITARY FIRM PISA - HOSPITAL - UNIVERSITY SANITARY FIRM S. CHIARA HOSPITAL - PISA S. CHIARA HOSPITAL - PISA Post-graduate Advanced Course on DIABETES AND PREGNANCY Pisa, Italy, February 22-23, 2008, Chairmen: G. Di Cianni, S. Del Prato OGASH Academy

2. XVII° Statistic Dossier Caritas/Migrantes 2007 “ I WAS STRANGER AND YOU RECEIVED ME IN YOUR HOMES …” Come, You that are blessed by my Father…Because whenever you did this for the least important of these brothers of mine, You did this for Me JESUS The Final Judgement Mt, 25, 34-36

3. ITALY AND MIGRATIONS Up to Date 2007: > 3.7 million immigrants living in Italy ! (6% of total population) ‏ From more than 191 Countries all over the world Middle-East Europe (Romania, Albania and Ucraina, Polonia), Northern Africa (Marocco, Algeria, Tunisia, Sudan, Libia) ‏ Eastern Asia (China, Philippines) Indiann Sub-continent (Pakistan, India, Sri Lanka). Women : 50%, age: 15-44 years (66%) ‏ Foreign Neonates: 1 out of 10 European Migration Network - Rapporto Caritas/Migrantes 2007

4. The impact of “pregnancy” on developing diabetes in Migrating Women. PREGNANCY Besides the Type I, Pregestational Diabetes, Women are at increased risk for developing diabetes during pregnancy : The form of the disease is known as Gestational Diabetes Mellitus (GDM) (in its various clinical patterns) and occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. Migrating Pregnant Women from Developing Countries present often extra risks to develop altered glycemic metabolism than others

5. “ MAJOR RISK FOR DIABETES “ in PREGNANT WOMEN MIGRATING FROM DEVELOPING COUNTRIES The determinants were found to include nutrition transition physical inactivity gene-environment interaction stress other factors such as ethnic susceptibility However, certain contradictory trends were also seen in some migrant communities and have been explained by various phenomena such as : “ healthy migrant effect “ adherence to traditional diets. Emerg. Themes Epidemiology v. 3, 2006

6. Issues: how to recognize GDM ? What is GDM ? Physical exercise Nutrition Therapy The Post-partum period Natality in the Migrants Community is significantly higher than in Italian Population. Diabetes rate in Pregnancy coyld be relevant. Project : “ DIABETES …to improve Communication and Mutual Understanding “ AUSL Reggio Emilia, Italy The Tables on Diabetes and Pregnancy (Prof. A. Lapolla) The internet web-site: www.modusonline.it/immigrati/ 12 tables translated in 14 languages, addressed to diabetic women who would like to have pregnancy and to the women at risk for diabetes during pregnancy

7. Pregestational Type 1 Diabetes: 2% Ceasarean Section rate: 37.7% large for date Babies : 3% IUGR: 13 % Mean GA at Delivery: 38 ws. Superimposed Preeclampsia: 2% Outpts. Check Frequency : 7-15 days; Follow up post partum: 3% Data collection: Dr Veronica Resi THE JOINT INTERDEPARTMENT DIABETOLOGIC-OBSTETRIC SERVICE for DIABETES and PREGNANCY at CISANELLO HOSPITAL : “Our Experience and Results ” (Hospital-University Department PISA-ITALY) Diabetologists: G. Di Cianni, L. Volpe, A. Bertolotto, C.Lencioni Gynaecologist: L. Battini Dietologist: M. Corfini Nurses: M. Carnevale, A. Favati, L. Tesi

8. FINAL MESSAGE: “ CARE “ GOALS ! to improve the Clinical Management of Diabetic Pregnants Migrating from Developing Countries Pregestational Diabetes ( type 1 > type 2 in reproductive years) : improve sensibility to pregnancy planning and early monitoring. Folic Acid pre-conceptional supplementation till to 12° week Pre and Gestational Diabetes: Careful nutritional and healthy lifestyle education Diabetic Ps. intensive clinical checking: every 7-15 days to verify the self- monitoring ability and the glyco-metabolic balance without and with Insulin- therapy Increased sensibility to postpartum glycaemic check and Breastfeeding Multidisciplinary integrated approach: Diabetologist, Obstetric, Dietologist Nurse, Midwife, Cultural Mediators