Biologically, a woman has different life stages that are determined mainly by her reproductive hormones and reproductive roles. These stages are mainly, pre-pregnancy, pregnancy, post-pregnancy, and menopause. The reproductive hormones and how they interact with other hormones, especially insulin can affect the way the body’s metabolism and make women prone to pre-diabetes.
In addition, at each life stage, a woman’s life is further influenced by her personal circumstances such as race/ethnicity, economic situation, access to health care, educational level, the physical environment where she lives or works, culture, and social structure of the community where she lives. These personal circumstances may contribute to stress and also influence the body’s metabolism and risk for developing pre-diabetes.
In this blog, we will discuss how each life stage and personal circumstances interact to make women of African descent prone to pre-diabetes.
Pre-pregnancy phase
The pre-pregnancy phase is the stage before a woman gets pregnant and it may be in her adolescent and adult life. The main condition that pre-disposes a woman to pre-diabetes at this phase is polycystic ovarian syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS)
An estimated one out of ten women of reproductive age are affected by PCOS, a complex health problem that is characterized by imbalances in the reproductive hormones. Women with PCOS experience irregular menstrual cycles, inability to ovulate, hirsutism (lots of hair all over their body), and sometimes the tendency to gain weight.
The imbalance in the reproductive hormones contributes to the increased release of insulin and also makes the body cells resistant to insulin. This insulin resistance may lead to increased blood sugar levels to the point of pre-diabetes. In middle age, women with PCOS are more likely to develop pre-diabetes and type 2 diabetes compared to women without PCOS. The risk of developing pre-diabetes is worsened by overweight or obesity.
Women of African descent with PCOS have a higher risk of cardiovascular risk factors compared to white women with PCOS. There is limited evidence on the underlying factors that contribute to this heightened cardiovascular risk among women of African descent with PCOS. However, there is evidence that personal circumstances such as poor economic situation, social disorder, living in poor physical environment, and exposure to discrimination are stressors that contribute to poor cardiovascular outcomes among women of African descent. These psycho-social stressors are also experienced by women of African descent with PCOS and further increase their risk for developing pre-diabetes and other cardiovascular risk factors.
Pregnancy phase
The pregnancy phase is also associated with risk factors that may make a woman of African descent likely to develop pre-diabetes. The main risk factor in this phase is gestational diabetes.
Gestational Diabetes Mellitus
The weight gain and change in hormones associated with pregnancy make a pregnant woman develop insulin resistance. Some pregnant women can produce enough insulin to overcome this insulin resistance while some cannot. Those who are unable to cope with this insulin resistance may experience an increase in their blood sugar levels during pregnancy. This is more common in women who are overweight, obese or gained a lot of weight during pregnancy.
Besides the biological changes in pregnancy that contribute to pre-diabetes, other psycho-social and cultural factors may cause a pregnant woman to develop gestational diabetes. For example, in some African cultures, pregnant women are encouraged to eat for themselves and the baby. This culture encourages eating without restraint and overlooks the harmful effects of excessive weight gain during pregnancy. This may also be compounded by other factors such as poor economic situations that make it difficult for women to buy and eat healthy foods. Other contributing stressors may include exposure to domestic violence, discrimination, poor physical environments, and workload.
Post pregnancy phase
The post-pregnancy phase is characterized by breastfeeding and caring for infants and children. Women who experience gestational diabetes during pregnancy are at higher risk of developing pre-diabetes after giving birth.
Breastfeeding
Breastfeeding generally improves insulin sensitivity and may protect against pre-diabetes. However, there are African cultural practices that encourage fattening and excessive eating to match the baby’s feeding pattern among women of African descent. This excessive eating may encourage post-pregnancy weight gain or retention of the weight gained during pregnancy. Being overweight or obese during breastfeeding may counter the metabolic benefits of breastfeeding and predispose women to pre-diabetes during this phase.
Non-breastfeeding mothers may not experience the benefits of breastfeeding on insulin sensitivity.
Caregiving
Caring for infants and young children is stressful. This is further compounded by workload from working within or outside the home.
It is also worsened by personal circumstances such as poor economic situation, exposure to domestic violence, poor physical environment, experience of discrimination, and poor access to health care that place additional stress on the caregiving process.
Stress causes the body to release stress hormones that cause insulin resistance and increase the likelihood of developing pre-diabetes.
Menopause
Menopause is that phase of a woman’s life when her monthly menstruation stops completely. This happens between the age of 50 and 60 years. Sometimes, it happens earlier or later.
Menopause is associated with hormonal changes that contribute to insulin resistance. After menopause, women tend to gain more weight, especially in their tummy. This is linked to insulin resistance and its increased risk for diseases of the heart and blood vessels.
Women in menopause also experience an increase in other cardiovascular risk factors such as high blood pressure, and increased cholesterol levels in their blood compared to younger women.
Preventing Type 2 Diabetes in women across all life stages
The good news is that at any phase of a woman’s life, progression to pre-diabetes and type 2 diabetes can be reduced by lifestyle changes in diet, physical activity, and stress management.
Regular blood sugar checks are imperative among women with PCOS, pregnancy, post-pregnancy, and menopause.
The Viedial Diabetes Prevention Program is tailored to suit the personal circumstances that women of African Descent are experiencing at each phase of their lives.
Sources
- World Health Organization. Polycystic Ovarian Syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome. Accessed 3rd April, 2024.
- Kazemi Jaliseh, H., Ramezani Tehrani, F., Behboudi-Gandevani, S., Hosseinpanah, F., Khalili, D., Cheraghi, L., & Azizi, F. (2017). Polycystic ovary syndrome is a risk factor for diabetes and prediabetes in middle-aged but not elderly women: a long-term population-based follow-up study. Fertility and sterility, 108(6), 1078–1084. https://doi.org/10.1016/j.fertnstert.2017.09.004
- Lee, I., Vresilovic, J., Irfan, M., Gallop, R., & Dokras, A. (2022). Higher Incidence of Metabolic Syndrome in Black Women With Polycystic Ovary Syndrome: A Longitudinal Study. The Journal of clinical endocrinology and metabolism, 107(4), e1558–e1567. https://doi.org/10.1210/clinem/dgab840
- Harris LK, Berry DC, Cortés YI. Psychosocial factors related to Cardiovascular Disease Risk in Young African American Women: a systematic review. Ethn Health. 2022 Nov;27(8):1806-1824. doi: 10.1080/13557858.2021.1990218. Epub 2021 Oct 20. PMID: 34668802; PMCID: PMC9018871.
- Mehrabani, H. H., Salehpour, S., Amiri, Z., Farahani, S. J., Meyer, B. J., & Tahbaz, F. (2012). Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. Journal of the American College of Nutrition, 31(2), 117–125. https://doi.org/10.1080/07315724.2012.10720017
- Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS. Cardiometabolic effects of breastfeeding on infants of diabetic mothers. World J Diabetes. 2023 May 15;14(5):617-631. doi: 10.4239/wjd.v14.i5.617. PMID: 37273257; PMCID: PMC10236993.
- Quansah, D. Y., Gross, J., Gilbert, L., Arhab, A., Horsch, A., & Puder, J. J. (2020). Predictors and consequences of weight retention in the early and late postpartum period in women with gestational diabetes. Diabetes research and clinical practice, 165, 108238. https://doi.org/10.1016/j.diabres.2020.108238
- Schenk, S., Ravussin, Y., Lacroix, A., Quansah, D. Y., & Puder, J. J. (2024). Weight Categories, Trajectories, Eating Behavior, and Metabolic Consequences during Pregnancy and Postpartum in Women with GDM. Nutrients, 16(4), 560. https://doi.org/10.3390/nu16040560
