Chronicaling Diabetes in Pregnancy: An Unseen Epidemic

Through the power of photojournalism, it's time to shine a spotlight on this not-so-niche epidemic that is harming our families, costing our health systems, and robbing the next generation of their full potential. We start in Sri Lanka, with one resilient woman named Nayani. 

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At De Soysa Hospital for Women in Sri Lanka, Nayani Nimeshika, 21, is one of the growing number of women treated for gestational diabetes (GDM). GDM is on the rise, now affecting 1 in 7 births around the world. 3/4 of the women affected live in low- and middle-income countries, where pregnancy and childbirth is already one of the most dangerous times in a woman's life.

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If diabetes in pregnancy is so common, why don't women know about it? With no family history of diabetes, Nayani never thought she'd be at risk. Three months into her pregnancy during a routine checkup at her local clinic, Nayani's latest blood glucose test came back. That's when everything changed. 

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After being diagnosed with GDM, Nayani was frightened. But in order for her baby to grow up healthy, she put fear aside and took action. “Whatever I have to do for the unborn child in order not harm it, I will do.” With diet change, an exercise plan, and insulin, Nayani managed her diabetes well enough to have a normal birth and healthy baby girl. Unfortunately, GDM stories don't always end this happily. 

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For most women, gestational diabetes doesn’t have any noticeable signs or symptoms. And in many countries, screening for gestational diabetes is not a part of standard pre-natal care. The diagnostic needs of pregnant women in low-and middle-income countries are woefully ignored, even though those regions account for 85% of of babies born every year and 88% of GDM cases. 

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Nayani was fortunate enough to attend a clinic that did consistently screen their patients. Without this vigilance, she would have never known of her condition, never accessed De Soysa Hospital for treatment, and her outcome might have been very different. 

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Children born to mothers with GDM are four to eight times more likely to develop type 2 diabetes later in life and baby girls of mothers with GDM are more like to suffer similar challenges during their own pregnancies—thereby perpetuating a vicious cycle of intergenerational ill health. It's crucial that Nayani's daughter is regularly monitored. 

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GDM has unintended consequences on many aspects of pregnancy and childbirth. It is estimated that 15% of the total number of caesarean sections may be due to gestational diabetes. 

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Nayani shares her new bundle of joy with nurses Kalani Rajasekara and A.A.I Shalika. Nurse Rajasekara (right) has been a Diabetes Educator Nursing Officer for three years. After attending a World Diabetes Day programme course, she was inspired to become an expert on diabetes management to better serve her patients. "I feel I am making a difference." 

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Nurse Rajasekara is right. The preventative care her patients receive now will help their health in the long run. Providing screening and care to mothers at risk of gestational diabetes, like Nayani, is likely to have a multi-generational impact on the beneficiaries as well as on health care systems and budgets.

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Nayani checks on her daughter, protected beneath a mosquito net. Now after the birth of her child, Nayani is determined to continue the changes she started during pregnancy.

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With the rates of GDM rising globally, these problems are only going to get worse. Recent projections show a 50% GDM increase as soon as 2035. At De Soysa Hospital for Women in Sri Lanka, health workers are desperately trying to turn that statistic around. 

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Today, it is the story of Nayani. 
Tomorrow, the stories of more women will follow, unless we act now to turn the tide on this silent epidemic.

Brittany Tatum