Poverty, instability linked to poor control of pregnancy diabetes

A close-up of a pregnant woman having her blood sugar/ glucose checked. (Jovanmandic)

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

These kinds of factors may be modifiable, the authors write in Obstetrics and Gynecology.

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

About 200,000 U.S. women develop diabetes during pregnancy each year, Colicchia said, and they must follow a strict diet, prick their fingers four times daily to check blood sugar, report their blood sugars to the doctor weekly, have frequent office visits and ultrasounds, and in many cases take insulin or medications several times daily to control their sugars.

"Gestational diabetes impacts every aspect of a woman's life including eating with and cooking for her family, scheduling her blood sugar checks and meals at work, where she obtains the food to follow the diet and how she creates time for everything," she said.

"Because of this, barriers to management of diabetes can come from any part of her life including her family, her neighborhood, her daily routine or her employer," she told Reuters Health by email.

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

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

They later analyzed medical records for blood sugar control and pregnancy outcomes, including infant size, maternal weight gain, cesarean delivery and newborn health.

Women were rated as having good blood sugar control if at least 70 percent of their blood sugar assessments were at goal level or better.

Overall, 86 of the 111 women achieved good glycemic control, either by diet changes alone or with the help of medication and insulin treatment. These women were more likely to be married, have higher household income and exercise three times a 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, though women receiving Supplemental Nutrition Assistance Program (SNAP) benefits tended to have worse blood sugar control.

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

"Women are not always able to change many things that make life chaotic such as unstable housing, unpredictable work schedules, poverty and family stressors," Colicchia said. "However, the gestational diabetes regimen in many cases can be adjusted to accommodate some of these factors, such as adjusting mealtimes or medication times to the woman's new schedule, or giving suggestions for healthy meals that can be eaten on the go or can be cooked ahead."

Women who lack material resources and live amidst hubbub and chaos brought on by caring for children and working and the absence of a partner may have more trouble controlling their blood sugar, said Nancy Ross of McGill University in Montreal who was not involved in the study.

"It seems like these women need help to lessen the 'hubbub and chaos' - perhaps shorter working hours, some breaks from caring for children to focus on shopping and meal preparation and having time to exercise," Ross said by email.

Doctors should ask women about the social factors relevant to diabetes care, and women should be honest with their doctors about the limitations 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 kids on the bus, or that her employer won't let her check her sugar after lunch we can make suggestions and adjustments to accommodate some of these factors," she said.