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Poverty, instability, linked to a lack of control of pregnancy diabetes

(Jovanmandic)

Pregnant women with pregnancy-related diabetes less likely to achieve blood sugar control as they rely on food stamps or have a generally chaotic lifestyle, according to a U.S. study.

This kind of factors can be changed, the authors write in the Obstetrics and Gynecology.

“Many social factors have a major impact on the overall pregnancy health,” said Dr. Laura Colicchia, who led the study at the University of Pittsburgh, and is currently in the Maternal-Fetal Medicine at Abbott Northwestern Hospital in Minneapolis.

About 200,000 U.S. women will develop diabetes during pregnancy each year, Colicchia said, and they must adhere to a strict diet, to prick their fingers four times a day to check blood sugar levels, report their blood sugars to the doctor weekly, and have frequent office visits and ultrasounds, and in many cases, the insulin or medications multiple times per day to keep their sugars.

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“Gestational diabetes has an impact on every aspect of a woman’s life including good food and cooking for her family, and the plans of her blood sugar checks and meals at work, where they obtain the food to follow the diet and how she makes time for everything,” she said.

“Because of this, the barriers for the management of diabetes can come from a part of her life, like her family, her neighborhood, her daily routine or her employer,” she told Reuters Health by e-mail.

Women who are obese, have limited access to food or from marginalized communities are at higher risk of gestational diabetes, and often higher blood sugar levels when diabetes is diagnosed, making it much harder to check, Colicchia noted.

The researchers surveyed 111 women with gestational diabetes at clinical visits, using questionnaires designed to measure social support and the extent of life “chaos” that includes the organization, the stability and the ability to plan and prepare for the future.

They later analyzed medical data for blood sugar control and pregnancy outcomes, such as baby size, maternal weight gain, caesarean section and new-born health.

Women were rated as having good blood sugar control if at least 70 percent of their blood sugar reviews were on the target level or better.

Overall, 86 of the 111 women achieved good glycemic control through diet changes alone or with the help of medication and insulin treatment. These women are more likely to marry, have a higher household income and the exercise three times per week, and less likely to have public insurance, or a history of depression or anxiety.

In general, food access and social support were not related to blood sugar control, although the women who are Supplemental Nutrition Assistance Program (SNAP) benefits tend to have worse blood sugar control.

Women with poor blood sugar control had higher scores on the chaotic lifestyle scale than people with good control, the authors also found.

“Women are not always able to change a lot of things that make life chaotic, such as unstable housing, unpredictable working hours, poverty and family stressors,” Colicchia said. “However, the gestational diabetes regimen in many cases can be adapted to some of these factors, such as the adjusting of the meals or medication times of the woman who the new plans, or give suggestions for healthy meals that can be eaten on the go or can be cooked ahead.”

Women who are lack of material resources and live in the midst of noise and chaos caused by the care for children and the work and the absence of a partner may have more difficulty controlling their blood sugar levels, said Nancy Ross of McGill University in Montreal, who was not involved in the study.

“It seems that these women should help lessen the ‘hustle and bustle and chaos’ – maybe shorter working hours, some breaks from caring for children to focus on the purchasing and preparation of meals and having time to practice,” he said by e-mail.

Doctors need to ask women about the social factors that are relevant to the care of the diabetes, and women should be honest with their doctors about the limitations that they face, Colicchia said. ‘

“If doctors and nutritionists know in advance that a woman will not be able to eat breakfast, because she has to get her children on the bus, or that her employer won’t let her sugar after the lunch, we can make suggestions and adjustments for some of these factors are,” she said.

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