Gestational diabetesis on the rise worldwide, and a new Canadian study said the reason for it may not be linked to previous speculation such as obesity, maternal age or lack of exercise.
The increase could be that screening methods for gestational diabetes — a type of diabetes that occurs during the second or third trimester of pregnancy — have improved.
The study out of British Columbia and published Monday in the Canadian Medical Association Journal (CMAJ) said in Canada, the rate of gestational diabetes rose to seven per cent in 2014 from four per cent in 2004 across all racial and ethnic groups.
“We were interested in understanding why rates of gestational diabetes were increasing in British Columbia. What we found was that rates of gestational diabetes … there was a change in the way that we screen for diabetes, which has really been taken up in British Columbia,” explained Elizabeth Nethery, lead author of the study and PhD in the School of Population and Public Health at the University of British Columbia.
“We’ve been using a much more sensitive method to screen, and we found that that change in screening practice has really led to the almost doubling of gestational diabetes cases in British Columbia.”
The jump in diabetes in pregnancy has previously been linked to maternal age (the risk of diabetes when pregnant goes up with age), less exercise and poor diet, but the authors argued this is likely not the case.
The researchers looked at data from more than 550,000 pregnancies in B.C. from 2005 to 2019 as well as screening methods. During the study period, diagnoses of gestational diabetes doubled, to 14.7 per cent from 7.2 per cent in the province, and so did the amount and type of screenings.
Change in gestational diabetes screening
In order for someone to be diagnosed with gestational diabetes, a glucose screening test needs to be completed.
“Fifteen to 20 years ago, screening was really considered more optional and that has changed. And now we recommend that everybody gets screened in pregnancy,” Nethery said.
Although it’s not mandatory, Diabetes Canada recommends that doctors screen all women between the 24th and 28th weeks of pregnancy.
There are two types of screenings that are used.
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The first type is a one-step screening method that consists of a single two-hour glucose tolerance test. The second type is a two-step screening method, which consists of a one-hour glucose challenge test, followed by a two-hour oral glucose tolerance test for patients who screen positive.
The advantage of the one-step screening is that only one laboratory visit is needed, but this single visit takes several hours and requires fasting and three blood samples, the study said.
“The difference with this kind of one-step approach is that it actually catches quite a lot more people than the previous methods that we were using,” Nethery explained, meaning the use of this method could lead to more diagnoses of gestational diabetes.
Whether it’s a one- or two-step approach, there isn’t a universal method for gestational diabetes screening in Canada. In fact, it varies not only from province to province, but also city to city.
Dr. Jennifer Yamamoto, assistant professor of internal medicine at the University of Manitoba, said because of the lack of uniformity, the glucose test is “quite controversial.”
“We see a lot of variety, whether people do the one- or two-step approach,” she said. “For example, at my centre here in Winnipeg, most people will do the two-step approach. But we still have a number of clinicians who are ordering the one-step approach. So it’s very practitioner-dependent and very regional.”
Currently, Diabetes Canada recommends the two-step gestational screening method.
Lack of screening data
Another problem of gestational diabetes screening is the method is not typically recorded in data registries or hospital discharge summaries, the authors said, and this could explain why the increase in cases of the condition remains unknown.
Although there is a lack of data, the B.C. researchers were able to examine the one- and two-step screening information using medical insurance billing. They then examined a group of pregnancies in B.C. using glucose tolerance screenings (either the one- or two-step process) between 2004 and 2019.
Between 2005 and 2018, screening for gestational diabetes in the province went up to 95.5 per cent from 87.2 per cent. And the use of the one-step screening methods went from zero in 2005 to 39.5 per cent in 2019, the study found.
The authors found the increase was largely due to changes in gestational diabetes screening practices, from a two-step screening process to a more sensitive one-step screening process.
“We found that change in screening in particular really bumped up the proportion of people that were being diagnosed (with gestational diabetes),” Nethery said.
Does screening improve outcomes?
Gestational diabetes can lead to a number of pregnancy complications if not properly managed. High blood sugar during pregnancy can lead to preeclampsia, abnormal sugar levels in the baby and possible birth injury due to the baby’s large size, according to Diabetes Canada.
Treatment for the condition can be as simple as lifestyle changes, like diet and physical activity; however, some women need to inject insulin in order to manage it.
After delivery, the condition usually goes away, but in severe cases, some women and babies can develop Type 2 diabetes later on in life.
Because gestational diabetes can require a lot of medical involvement during pregnancy (such as more tests and ultrasounds), the more people diagnosed, the more strain on the health-care system, Yamamoto said.
“While newer randomized controlled trials have demonstrated that the one-step approach diagnosis a lot more diabetes, it doesn’t actually improve outcomes at a population level,” she argued.
The one-step screening method picks up gestational diabetes at lower sugar levels, meaning health-care providers can pick up more “mild forms” of the condition.
“Andthose are the types of diabetes that maybe don’t benefit from the additional treatment, as we would see in people with more severe, higher blood sugars,” Yamamoto said.
Nethery agreed.
If a person is diagnosed with gestational diabetes, there are more tests, medical visits and ultrasounds and the person is more likely to be induced, she said.
“These not only have a cost to the system, but they also have a lot of individual implications for people,” she said. “And we are potentially kind of over-diagnosing people who especially are on the lower range of blood sugar.”
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VANCOUVER – Contract negotiations resume today in Vancouver in a labour dispute that has paralyzed container cargo shipping at British Columbia’s ports since Monday.
The BC Maritime Employers Association and International Longshore and Warehouse Union Local 514 are scheduled to meet for the next three days in mediated talks to try to break a deadlock in negotiations.
The union, which represents more than 700 longshore supervisors at ports, including Vancouver, Prince Rupert and Nanaimo, has been without a contract since March last year.
The latest talks come after employers locked out workers in response to what it said was “strike activity” by union members.
The start of the lockout was then followed by several days of no engagement between the two parties, prompting federal Labour Minister Steven MacKinnon to speak with leaders on both sides, asking them to restart talks.
MacKinnon had said that the talks were “progressing at an insufficient pace, indicating a concerning absence of urgency from the parties involved” — a sentiment echoed by several business groups across Canada.
In a joint letter, more than 100 organizations, including the Canadian Chamber of Commerce, Business Council of Canada and associations representing industries from automotive and fertilizer to retail and mining, urged the government to do whatever it takes to end the work stoppage.
“While we acknowledge efforts to continue with mediation, parties have not been able to come to a negotiated agreement,” the letter says. “So, the federal government must take decisive action, using every tool at its disposal to resolve this dispute and limit the damage caused by this disruption.
“We simply cannot afford to once again put Canadian businesses at risk, which in turn puts Canadian livelihoods at risk.”
In the meantime, the union says it has filed a complaint to the Canada Industrial Relations Board against the employers, alleging the association threatened to pull existing conditions out of the last contract in direct contact with its members.
“The BCMEA is trying to undermine the union by attempting to turn members against its democratically elected leadership and bargaining committee — despite the fact that the BCMEA knows full well we received a 96 per cent mandate to take job action if needed,” union president Frank Morena said in a statement.
The employers have responded by calling the complaint “another meritless claim,” adding the final offer to the union that includes a 19.2 per cent wage increase over a four-year term remains on the table.
“The final offer has been on the table for over a week and represents a fair and balanced proposal for employees, and if accepted would end this dispute,” the employers’ statement says. “The offer does not require any concessions from the union.”
The union says the offer does not address the key issue of staffing requirement at the terminals as the port introduces more automation to cargo loading and unloading, which could potentially require fewer workers to operate than older systems.
The Port of Vancouver is the largest in Canada and has seen a number of labour disruptions, including two instances involving the rail and grain storage sectors earlier this year.
A 13-day strike by another group of workers at the port last year resulted in the disruption of a significant amount of shipping and trade.
This report by The Canadian Press was first published Nov. 9, 2024.
The Royal Canadian Legion says a new partnership with e-commerce giant Amazon is helping boost its veterans’ fund, and will hopefully expand its donor base in the digital world.
Since the Oct. 25 launch of its Amazon.ca storefront, the legion says it has received nearly 10,000 orders for poppies.
Online shoppers can order lapel poppies on Amazon in exchange for donations or buy items such as “We Remember” lawn signs, Remembrance Day pins and other accessories, with all proceeds going to the legion’s Poppy Trust Fund for Canadian veterans and their families.
Nujma Bond, the legion’s national spokesperson, said the organization sees this move as keeping up with modern purchasing habits.
“As the world around us evolves we have been looking at different ways to distribute poppies and to make it easier for people to access them,” she said in an interview.
“This is definitely a way to reach a wider number of Canadians of all ages. And certainly younger Canadians are much more active on the web, on social media in general, so we’re also engaging in that way.”
Al Plume, a member of a legion branch in Trenton, Ont., said the online store can also help with outreach to veterans who are far from home.
“For veterans that are overseas and are away, (or) can’t get to a store they can order them online, it’s Amazon.” Plume said.
Plume spent 35 years in the military with the Royal Engineers, and retired eight years ago. He said making sure veterans are looked after is his passion.
“I’ve seen the struggles that our veterans have had with Veterans Affairs … and that’s why I got involved, with making sure that the people get to them and help the veterans with their paperwork.”
But the message about the Amazon storefront didn’t appear to reach all of the legion’s locations, with volunteers at Branch 179 on Vancouver’s Commercial Drive saying they hadn’t heard about the online push.
Holly Paddon, the branch’s poppy campaign co-ordinator and bartender, said the Amazon partnership never came up in meetings with other legion volunteers and officials.
“I work at the legion, I work with the Vancouver poppy office and I go to the meetings for the Vancouver poppy campaign — which includes all the legions in Vancouver — and not once has this been mentioned,” she said.
Paddon said the initiative is a great idea, but she would like to have known more about it.
The legion also sells a larger collection of items at poppystore.ca.
This report by The Canadian Press was first published Nov. 9, 2024.
