Expert meeting at the UN demands action now

New York, 8 April 2008 – Leading global health experts, UN agencies and Permanent Missions convened at the UN headquarters to take part in a expert meeting organised by the Global Alliance for Women’s Health (GAWH) and the World Diabetes Foundation (WDF). They all came to discuss policy issues and make recommendations for initiatives with a specific focus on Diabetes, Women and Development and its link to the Millennium Development Goals. 

The main meeting was attended by 22 leading experts, 32 delegates of whom six represented UN agencies, incl. UNICEF, World Bank, UN Division for the Advancement of Women, World Health Organization (WHO), Pan American Health Organization (PAHO) and United Nations Population Fund (UNFPA). The aim of the meeting was to spotlight the adverse relationship between diabetes and women’s health and wellbeing as well as to influence the public policy community to incorporate initiatives that would benefit several Millennium Development Goals..

The rapidly growing diabetes epidemic in the world means that pre-gestational and gestational diabetes contribute substantially to ‘high-risk’ pregnancies, and may already be the leading cause of high risk pregnancies in some countries. Undiagnosed or poorly managed diabetes or hyperglycaemia during pregnancy is associated with a significantly higher risk of maternal and peri-natal morbidity and mortality as well as poor pregnancy outcomes including spontaneous abortions, still births, congenital anomalies, macrosomia (large for gestational age), need for C-section, and assisted deliveries.

In her opening remarks, the Director of the UN Division for the Advancement of Women, Ms. Carolyn Hannan said; “With the General Assembly Resolution 61/225 efforts need to be made to use the resolution very strategically, to increase attention to women, gender equality and diabetes. The annual observance of the World Diabetes Day provides a unique opportunity to bring attention to women and diabetes. Efforts will be needed to identify the differences and inequalities between women and men in relation to risks, causes, consequences, treatment and coping strategies for diabetes”.

Tackling the problem of maternal health and diabetes

The rising prevalence of obesity, diabetes and impaired glucose tolerance (IGT) in the background population and the increasingly earlier onset, affecting even young adults in the reproductive age, means that increasingly more pregnancies are associated with diabetes either through women previously known to have diabetes becoming pregnant (pre-gestational diabetes), or through diabetes being first recognized during pregnancy (gestational diabetes). The reported prevalence rate of diabetes during pregnancy varies between 3 and 15% of pregnancies based on the background rates of diabetes. It is estimated that worldwide up to 10% of pregnancies may be associated with diabetes. Among high risk groups the prevalence rates may be as high as 30%. Almost 90% of all cases of diabetes during pregnancy are gestational diabetes.

In the developing countries poor women are far more likely to die as a result of pregnancy or childbirth. Women have limited access to healthcare facilities because of illiteracy, ignorance and negative social customs.

“Pregnancy offers a great window of opportunity to provide maternal care services not only to reduce the traditionally known maternal and peri-natal morbidity and mortality indicators but also for intergenerational and primordial prevention of several chronic diseases such as diabetes, hypertension, Cardiovascular and Cerebrovascular diseases. High quality interventions to improve maternal health have the potential for far reaching health and economic benefits”, explains Dr. Anil Kapur, Managing Director of the WDF.

Investing in sustainable programmes

According to UNFPA, every year, 536,000 women die from pregnancy-related causes. This means that more than 1 million children are left motherless and vulnerable

At the expert meeting high quality presentations and lectures documented that in the majority of cases, gestational diabetes can be adequately controlled with dietary modifications and increased physical activity. In order to get positive pregnancy outcomes, attempts must be made to achieve optimum metabolic control to normalize blood sugar level; using appropriate and best available treatment, including close monitoring, which should be made available to attain this objective.

Public health initiatives to address diabetes during pregnancy were recommended which can be easily integrated into the existing programmes for maternal and child health, as demonstrated through an initiative funded by the WDF in Tamil Nadu, India. Awareness-raising, advocacy and training are needed. There is an urgent need to initiate such programmes more widely, considering the fact that in addition to the known enhanced risk of maternal and peri-natal morbidity and mortality, undiagnosed and untreated diabetes during pregnancy may be fuelling the epidemic of diabetes through foetal programming.

Strategies to reduce gestational diabetes and improve maternal health in general will have a solitary effect on strengthening health care systems in such a way as to benefit all. Indeed, maternal health indicators are used to gauge health system performance in terms of access, gender equity and institutional efficiency.

“Investing in sustainable programmes focusing on maternal and child health including awareness and prevention of diabetes holds the promise of improving overall health services and delivery. In pursuit of MDGs 3, 4 and 5, the expert meeting hopefully paves the way for governments, UN agencies, donors and NGOs to include gestational diabetes in their maternal and child health agendas. WDF would be pleased to collaborate in terms of technical assistance and funding. Ultimately, no woman should die giving birth or carrying a child”, elaborates Ms. Sanne Frost Helt, Programme Manager at the WDF.

The expert meeting was sponsored by the Global Alliance for Women's Health and the World Diabetes Foundation, and was co-sponsored by:

WHO, the Permanent Missions to the United Nations of the Commonwealth of the Bahamas; People’s Republic of Bangladesh; Finland; Niger and the United Republic of Tanzania. We encourage you to read and download the recommendations from the expert meeting.

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