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WOMBI-325; No. of Pages 2 Women and Birth xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Women and Birth journal homepage: www.elsevier.com/locate/wombi
Letter to the Editor Comment on ‘‘Australian women’s experiences of living with gestational diabetes’’
Keywords: Diabetes GDM Gestational Diabetes Mellitus Psychological Re-naming Onomastic
Sir, We read with interest an article by Morrison et al., who report that negative experiences by women with history of gestational diabetes mellitus (GDM) overwhelm the positive ones.1 The experiences mentioned by the authors in Section 4.1, ‘‘Shock, fear and anxiety’’, highlight the psychological trauma a woman undergoes when diagnosed as GDM. In view of the interest of the journal in this field as revealed by another recently published review,2 we believe that the issue of psychological stress in GDM needs to be discussed further. The diagnostic tests of GDM are basically our effort to assess the degree of glucose tolerance. Subjects who do not ‘‘pass’’ these tests should be labelled exactly so: ‘glucose intolerant’, which sounds somewhat like the older term ‘‘carbohydrate intolerance of pregnancy’’, but is more specific. Evidence from large trials evaluating women for short term maternal and neonatal outcomes revealed that 80–90% of women were controlled on medical nutrition therapy alone.3,4 While many women may not develop diabetes after the index pregnancy for the rest of their life, others may do so at variable time interval. The rates of progression to diabetes may not even be akin to pre-diabetes, especially with newer American Diabetes Association (ADA) criteria for diagnosis.5 Do we, then, really need to couple the term ‘diabetes mellitus’ with ‘gestational’ which in literary sense is defined as ‘‘onset or first recognition in pregnancy’’ in the terminology of GDM.5 We recently discussed the need to rename the entity of GDM.6 Alternatives like Gestational Dysglycemia of Nutritional Origin (GDNO); ‘Pregnancy Related Intolerance to Glucose’ (PRIG) highlight the pathophysiology, primarily to reinforce the nearuniversal need for, and adequacy of medical nutrition therapy (MNT) in this condition. With this onomastic (re-naming) exercise, the negative effects of phrase ‘GDM’ can be minimised. Using such terms will reduce the shock, fear and anxiety of women with GDM, so elegantly described by Morrison et al.1 At the same time, deleting ‘diabetes’ from the name will in no way dilute the beneficial effects of MNT that these patient will be offered.
Re-naming of an entity, which has existed for decades may not be easy, and may be met by opposition and criticism. Some experts feel that avoiding the term ‘diabetes’ in GDM, will decrease the motivation to adopt healthy lifestyle in the postpartum period. This may impact the potential ‘importance’ of a GDM label in preventing future risk of diabetes. While this may be true for some, by and large it is the concern for the baby, and not for self, which motivates antenatal women to adopt a healthy lifestyle in pregnancy.7 This motivation is lost after successful delivery. A recent European study further supports these views.8 Though women were aware of the predisposition to diabetes, they did not always act to reduce this risk. The Australian Carbohydrate Intolerance Study provides evidence of the benefits of treating GDM on post-natal quality of life.3 However, this fact has not been validated outside the strict randomised controlled trial settings. A less threatening synonym, which describes this condition without causing shock, anxiety and fear, must be found. References 1. Morrison MK, Lowe JM, Collins CE. Australian women’s experiences of living with gestational diabetes. Women Birth )2013;(October). [Epub ahead of print, accessed 20.11.13]. 2. Devsam BU, Bogossian FE, Peacock AS. An interpretive review of women’s experiences of gestational diabetes mellitus: proposing a framework to enhance midwifery assessment. Women Birth 2013;26:e69–76. 3. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86. 4. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339–48. 5. American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care 2013;36(Suppl. 1):S11–66. 6. Kalra S, Baruah MP, Gupta Y, Kalra B. Gestational diabetes: an onomastic opportunity. Lancet Diabet Endocrinol 2013;1:91. 7. Carolan M, Gill G, Steele C. Women’s experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy Childbirth 2012;12:99http://www.biomedcentral.com/1471-2393/12/99. [accessed 25.10.13]. 8. Lie ML, Hayes L, Lewis-Barned NJ, May C, White M, Bell R. Preventing type 2 diabetes after gestational diabetes: women’s experiences and implications for diabetes prevention interventions. Diabet Med 2013;30:986–93.
Sanjay Kalra Bharti Hospital, Kunjpura Road, Karnal 132001, Haryana, India Yashdeep Gupta* Department of Medicine, Government Medical College and Hospital, Sector 32, Chandigarh 160030, India
1871-5192/$ – see front matter ß 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
http://dx.doi.org/10.1016/j.wombi.2013.12.003
Please cite this article in press as: Kalra S, et al. Comment on ‘‘Australian women’s experiences of living with gestational diabetes’’, Women Birth (2014), http://dx.doi.org/10.1016/j.wombi.2013.12.003
G Model
WOMBI-325; No. of Pages 2 2
Letter to the Editor / Women and Birth xxx (2014) xxx–xxx
Manash P. Baruah Excel Care Hospitals, Guwahati, Assam, India Bharti Kalra Bharti Hospital, Kunjpura Road, Karnal 132001, Haryana, India
*Corresponding author. Tel.: +91 9646121573. E-mail addresses: [email protected], [email protected] (Y. Gupta). 3 December 2013
Please cite this article in press as: Kalra S, et al. Comment on ‘‘Australian women’s experiences of living with gestational diabetes’’, Women Birth (2014), http://dx.doi.org/10.1016/j.wombi.2013.12.003
WOMBI-325; No. of Pages 2 Women and Birth xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Women and Birth journal homepage: www.elsevier.com/locate/wombi
Letter to the Editor Comment on ‘‘Australian women’s experiences of living with gestational diabetes’’
Keywords: Diabetes GDM Gestational Diabetes Mellitus Psychological Re-naming Onomastic
Sir, We read with interest an article by Morrison et al., who report that negative experiences by women with history of gestational diabetes mellitus (GDM) overwhelm the positive ones.1 The experiences mentioned by the authors in Section 4.1, ‘‘Shock, fear and anxiety’’, highlight the psychological trauma a woman undergoes when diagnosed as GDM. In view of the interest of the journal in this field as revealed by another recently published review,2 we believe that the issue of psychological stress in GDM needs to be discussed further. The diagnostic tests of GDM are basically our effort to assess the degree of glucose tolerance. Subjects who do not ‘‘pass’’ these tests should be labelled exactly so: ‘glucose intolerant’, which sounds somewhat like the older term ‘‘carbohydrate intolerance of pregnancy’’, but is more specific. Evidence from large trials evaluating women for short term maternal and neonatal outcomes revealed that 80–90% of women were controlled on medical nutrition therapy alone.3,4 While many women may not develop diabetes after the index pregnancy for the rest of their life, others may do so at variable time interval. The rates of progression to diabetes may not even be akin to pre-diabetes, especially with newer American Diabetes Association (ADA) criteria for diagnosis.5 Do we, then, really need to couple the term ‘diabetes mellitus’ with ‘gestational’ which in literary sense is defined as ‘‘onset or first recognition in pregnancy’’ in the terminology of GDM.5 We recently discussed the need to rename the entity of GDM.6 Alternatives like Gestational Dysglycemia of Nutritional Origin (GDNO); ‘Pregnancy Related Intolerance to Glucose’ (PRIG) highlight the pathophysiology, primarily to reinforce the nearuniversal need for, and adequacy of medical nutrition therapy (MNT) in this condition. With this onomastic (re-naming) exercise, the negative effects of phrase ‘GDM’ can be minimised. Using such terms will reduce the shock, fear and anxiety of women with GDM, so elegantly described by Morrison et al.1 At the same time, deleting ‘diabetes’ from the name will in no way dilute the beneficial effects of MNT that these patient will be offered.
Re-naming of an entity, which has existed for decades may not be easy, and may be met by opposition and criticism. Some experts feel that avoiding the term ‘diabetes’ in GDM, will decrease the motivation to adopt healthy lifestyle in the postpartum period. This may impact the potential ‘importance’ of a GDM label in preventing future risk of diabetes. While this may be true for some, by and large it is the concern for the baby, and not for self, which motivates antenatal women to adopt a healthy lifestyle in pregnancy.7 This motivation is lost after successful delivery. A recent European study further supports these views.8 Though women were aware of the predisposition to diabetes, they did not always act to reduce this risk. The Australian Carbohydrate Intolerance Study provides evidence of the benefits of treating GDM on post-natal quality of life.3 However, this fact has not been validated outside the strict randomised controlled trial settings. A less threatening synonym, which describes this condition without causing shock, anxiety and fear, must be found. References 1. Morrison MK, Lowe JM, Collins CE. Australian women’s experiences of living with gestational diabetes. Women Birth )2013;(October). [Epub ahead of print, accessed 20.11.13]. 2. Devsam BU, Bogossian FE, Peacock AS. An interpretive review of women’s experiences of gestational diabetes mellitus: proposing a framework to enhance midwifery assessment. Women Birth 2013;26:e69–76. 3. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86. 4. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339–48. 5. American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care 2013;36(Suppl. 1):S11–66. 6. Kalra S, Baruah MP, Gupta Y, Kalra B. Gestational diabetes: an onomastic opportunity. Lancet Diabet Endocrinol 2013;1:91. 7. Carolan M, Gill G, Steele C. Women’s experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy Childbirth 2012;12:99http://www.biomedcentral.com/1471-2393/12/99. [accessed 25.10.13]. 8. Lie ML, Hayes L, Lewis-Barned NJ, May C, White M, Bell R. Preventing type 2 diabetes after gestational diabetes: women’s experiences and implications for diabetes prevention interventions. Diabet Med 2013;30:986–93.
Sanjay Kalra Bharti Hospital, Kunjpura Road, Karnal 132001, Haryana, India Yashdeep Gupta* Department of Medicine, Government Medical College and Hospital, Sector 32, Chandigarh 160030, India
1871-5192/$ – see front matter ß 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
http://dx.doi.org/10.1016/j.wombi.2013.12.003
Please cite this article in press as: Kalra S, et al. Comment on ‘‘Australian women’s experiences of living with gestational diabetes’’, Women Birth (2014), http://dx.doi.org/10.1016/j.wombi.2013.12.003
G Model
WOMBI-325; No. of Pages 2 2
Letter to the Editor / Women and Birth xxx (2014) xxx–xxx
Manash P. Baruah Excel Care Hospitals, Guwahati, Assam, India Bharti Kalra Bharti Hospital, Kunjpura Road, Karnal 132001, Haryana, India
*Corresponding author. Tel.: +91 9646121573. E-mail addresses: [email protected], [email protected] (Y. Gupta). 3 December 2013
Please cite this article in press as: Kalra S, et al. Comment on ‘‘Australian women’s experiences of living with gestational diabetes’’, Women Birth (2014), http://dx.doi.org/10.1016/j.wombi.2013.12.003
