The risks for developing type 2 diabetes are many – increased weight gain, family history, poor diet, and lack of exercise are just a few that predispose a person to this disease. However, for women, there are two unique health conditions that can also put them on track for being diagnosed with this disease affecting around 34 million or one in 10 Americans – Polycystic Ovary Syndrome (PCOS) and Gestational Diabetes (GDM).
Polycystic Ovary Syndrome
PCOS is a condition that affects around 10% of women of reproductive age. It is generally characterized by elevated androgens, irregular ovulation, and metabolic abnormalities including insulin resistance. Women with PCOS are estimated to have a 2.5-fold increased prevalence of impaired glucose tolerance (IGT) and a four-fold increased prevalence of type 2 diabetes. PCOS is also an independent risk factor for GDM during pregnancy.
The etiology or beginnings of PCOS are not well understood. Doctors diagnosis a woman with PCOS if she has two of the three signs of this condition: irregular periods, excess androgen hormones (male hormones), and polycystic ovaries.
It’s believed that up to 70% of women with PCOS have some degree of insulin resistance that links directly to the development of type 2 diabetes. Another common co-morbidity often seen in women with PCOS is obesity that may also contribute to the association between PCOS and insulin resistance.
The main interventions or treatments for PCOS vary among women. At this time, there is no standard treatment that works best for all women with PCOS. This also includes a no one-size-fits-all dietary treatment for PCOS either. The main interventions to use are lifestyle and helping a woman with PCOS reach a healthier body weight by controlling her carbohydrate intake to no more than 130 grams of carbohydrates a day. This is important as some women with PCOS have an altered appetite regulation. They may not feel the sensation of fullness as quickly as women without PCOS and therefore may have more intense cravings for carbohydrates.
What can help women with PCOS with an altered appetite regulation is to reduce intake of concentrated simple carbohydrate foods or refined carbohydrates. These foods include cakes, cookies, pie, desserts, white bread and white rice, and all sugary beverages. Instead they should replace simple carbohydrates with complex carbohydrates such as whole fruits, vegetables, nuts, seeds, legumes, and whole grains.
These same women are also known to be more at risk of obstructive sleep apnea, which is common in women with PCOS. Once a diagnosis of PCOS has been made, they should also be screened for obstructive sleep apnea and to treat it appropriately to help women obtain adequate sleep.
GDM is a condition found in 5-9% of pregnant women in the U.S that is diagnosed in the second or third trimester. The majority of these women diagnosed with GDM did not have a prior diagnosis of type 2 diabetes. For the women diagnosed with GDM, more than 90% will have this condition resolve following the delivery of the baby.
GDM’s cause is not well understood but is likely multifactorial. What is well understood, however, is that any woman who has been diagnosed with GDM during any pregnancy will be at an increased risk (about 50%) for developing type 2 diabetes within 10 years.
Any woman with a prior history of GDM should receive follow-up care to screen for and prevent type 2 diabetes. The American College of Obstetrics and Gynecology recommends screening women with past GDM for prediabetes and type 2 diabetes between 4 and 12 weeks postpartum, and again every 1 to 3 years.
To prevent or at least delay the development of postpartum GDM women from developing type 2 diabetes, one of the best things a woman can do is to breastfeed her baby. Breastfeeding has been shown to improve insulin resistance and promote proper glucose tolerance and metabolism in women with past GDM. It’s also recommended these women have a long duration (up to a year or more) of breastfeeding as it is associated with a lower risk of type 2 diabetes. In fact, if a GDM postpartum woman breastfeeds for at least 2 months, this has been shown to lower the mother’s risk of developing type 2 diabetes by 50%. These same women are more likely to return to and maintain a healthy weight. This is important as maintaining a healthy weight is believed to be one of the most important modifiable risk factors in preventing diabetes, to begin with.
It is also advised that these women work with a registered dietitian for personalized dietary care emphasizing practical and sustainable healthy eating patterns helping lower the risk for diabetes.
Any woman diagnosed with either PCOS or GDM needs frequent follow-ups with healthcare professionals helping them reach specific health goals. These healthcare professionals should include a registered dietitian, an endocrinologist, an OB/GYN specializing in maternal-fetal medicine, and other support healthcare professionals depending on specific needs.
The earlier intervention is begun with either condition, the greater likelihood of helping women with these conditions, avoid or at least delay, a diagnosis of type 2 diabetes and the various complications that go with it.