Creating the Diagnosis of Gestational Diabetes: A Brief History of Gestational Diabetes Part 2
Be sure to read Part 1 of this series here!
By the early twentieth-century, doctors knew that some women, at that time it seemed to be mostly white women, had sugar appear in their urine toward the end of their pregnancies. They also knew that this condition went away when the mother gave birth. In 1954, a doctor in Boston began a ten year study to see if this condition was an early warning sign for these women developing diabetes later in their lives. Dr. John O'Sullivan reported in 1964 that, in fact, these women were likely to develop diabetes in the next ten years.
The change from urine testing to blood testing to diagnose diabetes or pre-diabetes also meant that women whose bodies could tolerate more sugar in their blood before it spilled into their urine would now be labeled with diabetes. This identified many more low-income, overweight, and non-white women with high blood sugars during their pregnancies. In fact, all types of diabetes became poorer and less white during the twentieth-century. Part of that trend can be attributed to better access to health care for the public because people can only be counted if they show up for care to begin with and in the early years of the twentieth century only wealthy people could afford health care. But as we can see here, another important reason for the change in the face of diabetes in general, and in gestational diabetes in particular, is the way diabetes is diagnosed. Blood sugar is now the standard test and the cut-off number for abnormal has become lower and lower.
In the 1970s, the World Health Organization began work on a new edition of their international manual of disease codes. A committee was formed in the United States to restructure the categories for diabetes, the National Diabetes Data Group (NDDG). A physician-researcher who had recently been appointed to head the newly created Diabetes and Pregnancy Center at Northwestern University in Chicago, Dr. Norbert Freinkel, used the opportunity to craft a formal recommendation that the NDDG add Gestational Diabetes Mellitus to the classification system for diabetes.
In 1979, the new diagnostic manual came out and Gestational Diabetes Mellitus had been added to the category of diabetes. The new addition, however, created enormous controversy. Arguments arose over whether this was really a disease, over whether the diagnosis placed an unnecessary stigma on women, about how gestational diabetes should be diagnosed, and about whether the disease label was unfairly singling out low-income and non-white women.
In supporting the inclusion of gestational diabetes in the new classification system, a workshop in 1984 reported that the diagnosis was necessary in order to convince women that their pregnancies were at higher risk for problems and that they needed to modify their health behaviors in order to avoid future problems. The powerful influence of the growing health care market showed up in the final summary statement. The diagnosis was necessary in order to "communicate [this] need ... to providers of third-party payments or others responsible for the financing of health care delivery."
The most current research on gestational diabetes confirms that these women and their children are at greater risk for developing Type 2 diabetes in later life. The research also verifies that there is a direct relationship between how high a pregnant woman's blood sugar rises and how many problems she experiences with her pregnancy. But, the diagnosis remains controversial because it is difficult to define and because there is a negative social perception due in part to the way that women are defined as consumers in the health care market.