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Prediabetes And Pregnancy - All You Need To Know

The rise in a sedentary lifestyle coupled with poor eating habits, physical inactivity, and urbanization has led to a plethora of public health concerns across the world.

Introduction

Diabetes mellitus is considered the most prevalent of them all, affecting more than 530 million adults globally<a href="#accordion">[1]</a>. The insidious condition affected an estimated 26.7% of Pakistani adults in 2022[2]. Unfortunately, these numbers have shown a sharp increase over the years, and show no signs of slowing down. According to the projections by the International Diabetes Federation (IDF), global prevalence is predicted to rise to 643 million by 2030<a href="#accordion">[1]</a>. 
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Think things can&rsquo;t get any worse than that? Enter prediabetes, the precursor to diabetes. Currently, around 319 million people worldwide are dealing with prediabetes, and that number is expected to swell to an unfortunate 441 million by 2045. This means even more people are at risk of crossing over into full-blown diabetes territory<a href="#accordion">[3]</a>.

Now, imagine this scenario getting even trickier: you&#39;re pregnant. That&#39;s when things get even more complex.<a href="https://merisehat.pk/disease/pcos-and-pregnancy-common-faqs"> Pregnancy </a>has a unique way of magnifying health issues, and when prediabetes enters the picture, it&#39;s like a double challenge. This article dives headfirst into the fascinating world where prediabetes and pregnancy meet. But first, what is prediabetes? 
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Understanding The Impact of Prediabetes on Pregnancy

Prediabetes is like a whispered caution from our bodies, a stage that sits right on the turning point between normal blood sugar levels and full-fledged diabetes. It is characterized by blood sugar levels that are higher than the ideal range for a healthy individual, yet not quite high enough to be classified as diabetes.

There are varying definitions and diagnostic criteria for prediabetes. The WHO defines prediabetes in terms of fasting plasma glucose. A fasting blood sugar level between 6.1 mmol/L (110 mg/dL) and 6.9 mmol/L (125 mg/dL) indicates prediabetes. Similarly, during an oral glucose tolerance test, a blood sugar reading between 7.8 mmol/L (140 mg/dL) and 11.0 mmol/L (199 mg/dL) two hours after consuming a glucose-rich solution also falls within the prediabetes range<a href="#accordion">[4]</a>. 
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In Pakistan, the prevalence of prediabetes is estimated to be around 11.4%, with women being affected more than men<a href="#accordion">[5]</a>.

Many people feel a sense of impending doom when they receive a prediabetes diagnosis. Fortunately, prediabetes does not mean a guaranteed transition to type 2 diabetes. Instead, think of prediabetes as a pivotal juncture, a crucial opportunity to take charge of your health. While you may not have fully crossed into diabetes territory, your body is sending a clear signal that it&#39;s time to make some positive changes.

But what if you&rsquo;re pregnant? Is prediabetes still reversible? Can prediabetes alter the course of your pregnancy or increase the risk of gestational diabetes? Questions, questions, and more questions! 
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Research suggests that prediabetes, characterized by elevated blood sugar levels, can exert a significant impact on fertility, both in men and women<a href="#accordion">[8]</a>.

For women, prediabetes can disrupt the delicate hormonal balance necessary for a healthy menstrual cycle and ovulation. Irregular or absent menstrual periods, a common consequence of prediabetes, can hinder the ability to conceive. Additionally, elevated blood sugar levels can lead to insulin resistance, which may contribute to anovulation (lack of ovulation) and other fertility challenges<a href="#accordion">[8]</a>. 
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In men, prediabetes can affect sperm quality and function. High blood sugar levels can lead to oxidative stress and inflammation, which may impair sperm production, motility, and morphology. These factors can reduce the chances of successful fertilization and conception<a href="#accordion">[7]</a>.

Addressing prediabetes through lifestyle changes, such as adopting a healthy diet, engaging in regular physical activity, and managing stress, not only reduces the risk of developing type 2 diabetes but also plays a vital role in promoting fertility and optimizing reproductive health for both men and women. 
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According to research, women with prediabetes are at high risk for developing gestational diabetes during pregnancy<a href="#accordion">[9]</a>. Furthermore, prediabetes in early pregnancy is linked to an increased risk of adverse pregnancy outcomes<a href="#accordion">[10]</a>. Therefore, experts recommend early diabetic screening for women with prediabetes. 
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A 2015 study assessed the benefits of early treatment on women with prediabetes during pregnancy. The study participants either received routine care or treatment for GDM with dietary intervention and insulin as needed. While the treatment and control groups had no difference in the primary outcome (positive glucose tolerance test), the early treatment did lead to lower A1C levels in women with prediabetes. Furthermore, in non-obese women, the treatment reduced the rate of gestational diabetes<a href="#accordion">[11]</a>. 
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While a complete reversal of prediabetes during pregnancy may be challenging, adopting a healthy lifestyle can help manage blood sugar levels effectively. Making positive changes in diet, exercise, and overall wellness can contribute to improved insulin sensitivity and may prevent the progression of prediabetes to type 2 diabetes. Moreover, some patients may be prescribed metformin. Especially, people who are obese or women with a history of gestational diabetes<a href="#accordion">[6]</a>. 
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Conclusion

By actively managing prediabetes through healthy lifestyle choices, pregnant women can optimize their health and the health of their developing child. With vigilant monitoring, personalized healthcare guidance, and a commitment to well-being, expectant mothers can navigate this complex intersection with confidence and the promise of a healthier future. 
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Remember, if you find out you&rsquo;re prediabetic, seek the help of a nutritionist that can help create a healthy diet and exercise plan for you so you can have a healthy pregnancy.&nbsp; 
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[1] IDF Diabetes Atlas. International Diabetes Federation.

[2] Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg (Lond). 2022;79:103901. Published 2022 Jun 3. doi:10.1016/j.amsu.2022.103901

[3] Ampeire, I.P., Kawugezi, P.C. & Mulogo, E.M. Prevalence of prediabetes and associated factors among community members in rural Isingiro district. BMC Public Health 23, 958 (2023). DOI:10.1186/s12889-023-15802-9

[4] Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296-303. doi:10.4239/wjd.v6.i2.296

[5] Akhtar S, Nasir JA, Abbas T, Sarwar A. Diabetes in Pakistan: A systematic review and meta-analysis. Pak J Med Sci. 2019;35(4):1173-1178. doi:10.12669/pjms.35.4.194

[6] Insulin Resistance & Prediabetes. National Institute of Health.

[7] Boeri L, Capogrosso P, Ventimiglia E, et al. Undiagnosed prediabetes is highly prevalent in primary infertile men - results from a cross-sectional study. BJU Int. 2019;123(6):1070-1077. doi:10.1111/bju.14558

[8] R Lisa. Fertility, Pre-Diabetes & Diabetes: Everything You Need To Know. illume fertility.

[9] Diabetes Mellitus and Pregnancy. Medscape.

[10] Hughes RCE, Rowan J, Williman J. Prediabetes in pregnancy, can early intervention improve outcomes? A feasibility study for a parallel randomized clinical trial. BMJ Open. 2018;8(3):e018493. Published 2018 Mar 3. doi:10.1136/bmjopen-2017-018493

[11] Osmundson S, Norton M, El-Sayed Y, Faig J, Carter S, Kitzmiller J. 35: Early treatment of women with Prediabetes in pregnancy: A randomized controlled trial. American Journal of Obstetrics and Gynecology. 2015;212(1). doi:10.1016/j.ajog.2014.10.081

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