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Hyperglycemia and Pregnancy in the Americas

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Hyperglycemia and Pregnancy in the Americas HYPERGLYCEMIA AND PREGNANCY IN THE AMERICAS Final report of the Pan American Conference on Diabetes and Pregnancy Lima (Peru), 8-10 September 2015 HYPERGLYCEMIA AND PREGNANCY IN THE AMERICAS Final report of the Pan American Conference on Diabetes and Pregnancy Lima (Peru), 8-10 September 2015 Washington, D.C., 2016. Also published in Spanish (2016): Hiperglucemia y embarazo en las Américas: Informe final de la Conferencia Panamericana sobre Diabetes y Embarazo (Lima, Perú. 8-10 de setiembre del 2015) ISBN 978-92-75-31883-6 PAHO HQ Library Cataloguing-in-Publication Data ****************************************************************************************************** Pan American Health Organization. Hyperglycemia and Pregnancy in the Americas. Final report of the Pan American Conference on Diabetes and Pregnancy (Lima Peru: 8-10 September 2015). Washington, DC : PAHO. 2016 1. Diabetes Mellitus. 2. Hyperglycemia. 3. Pregnancy. 4. Pregnancy in Diabetics. 5. Maternal and Child Health. 6. Americas. I. Title. ISBN 978-92-75-11883-2 (NLM Classification:WQ248) © Pan American Health Organization, 2016. All rights reserved. The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Communications Department, Pan American Health Organization, Washington, D.C., U.S.A. (www.paho.org/permissions). The Department of Noncommunicable Diseases and Mental Health will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. The Pan American Conference on Diabetes & Pregnancy was supported by the World Diabetes Foundation This report was prepared by Alberto Barceló, Noël C. Barengo, Jose Roberto da Silva Jr., Sara Meltzer and Gojka Roglic with contributions from the following conference participants: Juan Daniel Aspilcueta Gho, Marcos Augusto Bastos Dias, Hector Bolatti, Adriano Bueno Tavares, Luis Cabero, Evelina Chapman, Anders Dejggard, Mina Desai, José A Escamilla, Maria Cristina Escobar, Ricardo Juan García Cavazos, Jacinto Lang, Silvia Lapertosa, Gloria Larrabure, Bent Lautrup-Nielsen, Javier Maldonado, Beatriz Martins da Costa Maciel, Lenildo Moura, Eloisa Nuñez, Socorro Parra, Vivian Perez, Ludovic Reveiz, Enrique Reyes, Aleida Rivas, Karen Roberts, Michael Ross, Susana Salzberg, Segundo Seclen, Suzanne Serruya, Andrea Srur, Angelica Valdivia The section Diabetes & Pregnancy in the Americas was prepared with data form Ministries of Health from Argentina, Barbados, Belize, Cuba, Chile, Dominica, El Salvador, Guatemala, Guyana, Mexico, Panama, Peru, Puerto Rico and Venezuela; the Public Health Agency of Canada; and the US Centers for the Disease Control and Prevention (Maternal and Infant Health, Division of Reproductive Health). Pictures included in this report (with exception of those appearing in pages 38, 42 and 44) are from the Pan American Conference on Diabetes & Pregnancy that took place in Lima Peru, 8-10 of September of 2015. Photos: Luis Eduardo Macchiu Photos pages 38, 42, 44: 123rf.com Design: Sandra Serbiano Contents Acronyms ............................................................................................................................................. 4 Introduction ............................................................................................................................................. 7 Diabetes y embarazo en las Américas: análisis de situación ..........................................................7 Diabetes Mellitus (DM) and its burden in Latin America & the Caribbean ....................................... 17 Prevalence of diabetes in the Americas .......................................................................................... 17 The cost of diabetes in Latin America and the Caribbean ............................................................. 19 Diabetes screening and diagnosis in pregnancy ............................................................................ 20 Cost-effectiveness of GDM screening ............................................................................................. 24 Treatment of diabetes in pregnancy ................................................................................................ 26 Education and gestational diabetes ................................................................................................ 27 Diet .....................................................................................................................................................28 Physical exercise ............................................................................................................................... 29 Medical treatment ............................................................................................................................. 30 Future risk for mother and child: Maternal health and noncommunicable diseases ..................31 Gestational diabetes: Puerperium ................................................................................................... 32 Fetal programming ........................................................................................................................... 32 Teamwork session ................................................................................................................................. 35 Health care organization ................................................................................................................... 35 Community resources, public policies, creation of networks, communication ..........................35 Guidelines, protocols, and research ................................................................................................ 35 Health services delivery ................................................................................................................... 37 Support for self-management .......................................................................................................... 37 Information system ........................................................................................................................... 37 Organization of health care ............................................................................................................. 37 Community resources, public policies, creation of networks, and communication .......................................................................................................................... 39 Guidelines, protocols, and research ................................................................................................ 39 Health services delivery ................................................................................................................... 40 Support for self-management .......................................................................................................... 40 Monitoring and information system ............................................................................................... 40 Conclusions of the conference ............................................................................................................ 43 Recommendations of the conference ................................................................................................. 45 Hyperglycemia in pregnancy: A call to action for improved outcomes ............................................47 Why is hyperglycemia in pregnancy a health problem? ..............................................................47 The burden of diabetes in pregnancy in the Americas .................................................................. 48 Recommendations for health workers ............................................................................................ 48 Measures to be taken by health authorities and health professionals ........................................48 Action that the PAHO/WHO secretariat should take ...................................................................... 49 Annex 1. Data Collection Form Diabetes & Pregnancy ......................................................................
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