Diabetic Moms Portend China’s Looming Chronic Disease Crisis
Luo Ting is snacking on a salt-free cracker in a Beijing maternity ward, part of a regimen to curb the glucose in her blood that threatens to cause lifelong harm to the baby she’s due to deliver this week.
Luo, a 29-year-old sales clerk, says she didn’t know pregnancy could trigger gestational diabetes until a test in April. Now she’s among 15 percent of expecting mothers in Beijing who develop the condition, which can spur excessive fetal growth and raises the diabetes risk for them both.
As China’s population of diabetes sufferers approaches 100 million, health officials are trying to arrest an obesity-driven explosion in cases that’s stretching hospitals and striking down working age men and women. The disease afflicts 1 in 10 adults in China, making it almost as common as in the U.S., and costs about $26 billion a year in medical bills, according to the International Diabetes Federation.
“Their health system in the big cities is completely overwhelmed now by diabetes,” said Ann Keeling, chief executive officer of the Brussels-based federation, in an interview. “They can’t deal with the numbers that they’ve got coming through.”
The global burden of diabetes and other so-called non- communicable diseases may hinder development, according to the United Nations, which will discuss the issue at a meeting in New York Sept. 19-20. The talks will address research showing how maternal nutrition influences the risk of obesity and heart disease for both the mother and child in later life.
Luo’s doctor Yang Huixia is studying the link at Peking University First Hospital, which began screening pregnant women for gestational diabetes in 1994. The rate more than tripled from 3-4 percent in 17 years, Yang said. In Australia, about 5 percent of women delivering babies in 2008 were diagnosed with the condition.
The increase may be because about half of pregnant women put on more weight than recommended, Yang said. Luo said she gained 4 kilograms in the first three months of her pregnancy, more than double what she was advised.
Luo’s mother and mother-in-law indulged her craving for fruit and her favorite dish -- stir-fried chicken with dried chili and cashew nuts, she said.
“I could eat five oranges at a go,” said Luo, who had a pre-pregnancy weight of 58 kilograms, within a healthy range for her 1.62-meter height. “I had meat or fish every day, which I didn’t before I became pregnant.”
Now Luo is getting six energy-controlled meals a day in the four-bed ward at Peking University First Hospital, where she was admitted on Aug. 25.
“It’s really quite tasteless, but I’m used to it,” Luo said, reclining on her metal-framed bed.
The willingness for grandparents to over-nourish pregnant women reflects a mistaken belief that it will produce “healthy, plump babies,” said Yang. Instead, it may increase the mother’s blood-glucose level and exacerbate a decrease in insulin sensitivity caused by the pregnancy.
High sugar levels in the blood can pass through the placenta to the baby, causing the fetus to increase insulin production and store excess energy as fat. Fatter babies are harder to deliver and tend to develop risk factors for diabetes and stroke in childhood.
Studies in Hong Kong found children exposed to excess blood sugar in the womb had higher blood pressure and a greater tendency toward obesity at age 7 compared with those whose mothers didn’t have gestational diabetes, said Juliana Chan, founding director of the Chinese University of Hong Kong’s Institute of Diabetes and Obesity.
“We know these are traits which predict diabetes in the future,” Chan said in an interview. In addition, half of pregnant women like Luo who have gestational diabetes will develop Type 2 diabetes within 15 years, according to Chan, who is also a consultant endocrinologist at Hong Kong’s Prince of Wales Hospital.
The tendency to develop gestational diabetes may be greater in China, India and other developing economies, where a legacy of poverty and hunger led to adaptive biological changes that helped people survive in times of famine, said Kausik Ray, professor of cardiovascular disease prevention at St George’s University of London.
For individuals with metabolisms equipped for deprivation, calorie-loaded food and a lack of physical activity can be “toxic,” leading to an earlier onset of obesity-linked illnesses, Ray said in an interview.
The proportion of overweight adults in China has doubled over the past 15 years, while the obesity rate has tripled, according to the Organization for Economic Cooperation and Development. Now, one in three men and one in four women are overweight.
“China went through a period of material deprivation in the 1970s and before that, so whoever had a plump baby at home had something worth boasting about,” said Yang, the diabetes specialist. “This is the kind of cultural background that we have to deal with today.”
Yang’s research has shown women who develop gestational diabetes are seven times more likely to become diabetic than women who avoid the condition. The risk is increased further if they follow traditional postnatal practices, she said.
“There’s a practice called ritual confinement after birth, where for a period a woman’s parents or mother-in-law will feed her brown sugar dissolved in water which they believe will replenish blood lost during birth,” Yang said.
Those with gestational diabetes who follow the practice typically have elevated blood-glucose levels six weeks after delivery, when their metabolic problem would normally have resolved, she said.
More than 92 million adults in China have Type 2 diabetes, a survey last year found. Another 148 million Chinese are on their way to developing the disease, which increases the chance of dying prematurely from stroke and heart attack, and complications like blindness and kidney failure.
Reducing mortality from cardiovascular diseases by 1 percent a year in China over three decades ending in 2040 could generate an economic value equivalent to 68 percent of China’s 2010 real gross domestic product, or $10.7 trillion, the World Bank said in a report in July.
“People with chronic illness are often less productive at work, they tend to work fewer hours and they retire earlier,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. The cost of lifelong medical treatment may also impoverish them and their families, he said.
Luo, the Beijing mother-to-be, is trying to avoid that.
“I was very scared when I found out I had gestational diabetes, so I’ve forced myself to control my diet,” she said. “Our parents are all very understanding, as they knew it’s the best thing for the baby too.”
--Daryl Loo, Natasha Khan. Editors: Jason Gale, Bret Okeson
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