Gestational Diabetes in the Bronx: A Legislative and Scientific Exploration - Paper Example

Description of Issue

The issue selected for analysis is gestational diabetes among black women in the Bronx. Gestational diabetes is a condition where an individual's blood sugar levels are high during pregnancy. According to Jaffe et al. (2019), the disease affects 10% of pregnant women in the United States every year. Gestational diabetes mellitus is an established risk factor for various infant health outcomes such as birth trauma, fetal macrosomia, neonatal hypoglycemia, and death of the fetus (Jaffe et al., 2019). Over the years, medical personnel have used the condition to predict type 2 diabetes' maternal development among patients.

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Importance of the Issue

Notably, gestational diabetes mellitus is a disorder that affects a significant number of black women during pregnancy. According to Parrinello et al. (2015), gestational diabetes among black women in the Bronx is an issue that needs a policy improvement plan since most women are unaware of the condition, the risk factors, and preventive measures. The condition can easily be prevented if those with a high propensity for gestational diabetes adopt the techniques for managing the condition. Recognition of the propensity provides patients with a chance to undertake lifestyle measures to reduce the risks of diabetes. Understanding the condition enhances the formation of policies that encourage frequent screening for diabetes, allowing for the institutionalization of interventions before establishing end-organ consequences of diabetes.

Science Section

Epidemiological Scope of the Problem: Statistics

The extent of gestational diabetes mellitus is dependent on an individual's race and ethnicity. The rates of gestational diabetes are high among blacks, Asians, Hawaiians, Pacific Islanders, and Hispanic women (Dinapoli & Bleiwas, 2018). Not enough reasons exist to explain why blacks are at a high risk of developing gestational diabetes. Similarly, Jaffe et al. (2019) stipulated that the prevalence of gestational diabetes is positively correlated to a patient's race and culture, with high rates among blacks and Native Americans compared to whites. Typically, about 1.5 to 2% of white women develop gestational diabetes (Dinapoli & Bleiwas, 2018). In contrast, about 5-8% of the black population develop gestational diabetes, and their recurrence rates in subsequent pregnancies are as high as 68% (Dinapoli & Bleiwas, 2018). Additionally, about a third of the people who develop gestational diabetes are likely to have type 2 diabetes within five years after delivery (Dinapoli & Bleiwas, 2018).

Hispanics and Latinos are the highest population in the Bronx in number and account for 48.3% of the Bronx (Dinapoli & Bleiwas, 2018). The blacks or African Americans are the second highest in number accounting for 35.64% of the population (Dinapoli & Bleiwas, 2018). Considering that blacks are at a high risk of diabetes and, in particular, gestational diabetes, one can see why the condition is a menace for the region's people. The high rates of gestational diabetes among blacks in the Bronx region create a community burden.

The women at a higher risk of gestational diabetes are obese, older people above 35 years, and have family members with diabetes. Additionally, an individual is at a greater risk of developing gestational diabetes if they belong to an ethnic group with a high prevalence of the disease. The increasing prevalence of diabetes worldwide signifies the need to develop an affordable and effective prevention strategy that entails identifying high-risk populations. The Diabetes Prevention Program is one of the institutions concerned with diabetes management that can formulate policies and programs that aid in effectively preventing diabetes among risk populations (Jaffe et al., 2019).

Medical/Scientific Explanation of the Problem

During a normal pregnancy, the body undergoes several physiological changes critical in supporting the fetus’s demands. Some of the changes in an individual’s body include cardiovascular, hematologic, renal, metabolic, and respiratory systems (Plows et al., 2018). One of the critical metabolic adaptations is sensitivity to insulin. Throughout pregnancy, insulin sensitivity shifts based on the requirements of pregnancy (Plows et al., 2018). During the initial stages of pregnancy, a person’s sensitivity to insulin increases, hence promoting glucose intake into the fatty tissues to ensure enough energy in the later pregnancy stages. However, as the pregnancy progresses through the different stages and trimesters, hormones of the local and placenta hormones such as estrogen, leptin, cortisol, progesterone, placental lactogen, and growth hormone yield resistance to insulin (Plows et al., 2018). In effect, the levels of glucose in the blood increase. The glucose is transported towards the placenta to enhance the growth of the fetus.

The mild resistance to insulin leads to endogenous glucose production, and the breakdown of fat stores leading to a further increment of glucose and fatty acid concentrations in the body (Plows et al., 2018). Maintaining the expected glucose levels in the blood requires pregnant women to compensate for the changes through hypertrophy and hyperplasia of the pancreas’ beta cells. Another process of maintaining homeostasis is through glucose-secretion insulin secretion (GSIS) (Plows et al., 2018). The placental hormones have a substantial role in this process since, after delivery, the insulin sensitivity returns to pre-pregnancy levels.

The risk factors for gestational diabetes mellitus are age, obesity, family history of diabetes, and hypertension. Notably, a predisposition to gestational diabetes is characterized by a family history of diabetes, previous gestational diabetes in pregnancies, metabolic syndrome factors, and a low lifestyle (Plows et al., 2018). The probability of gestational diabetes increases with a person’s age. According to Meng et al. (2016), smooth muscle and nuclear antibodies are higher among gestational diabetes patients. In a study by Meng et al. (2016), gestational diabetes subjects were obese and overweight. Others have a low frequency of the Bf-F phenotype and a higher frequency of the Bf-F1 phenotype (Meng et al., 2016). People at risk of gestational diabetes also have a low frequency of type 2 alleles at the locus adjacent to the insulin gene (Meng et al., 2016). All these factors provide a scientific explanation of why gestational diabetes is frequent among blacks instead of whites in the Bronx region.

Insufficient Current Treatments or Solutions to the Problem

According to Daneshmand et al. (2019), understanding how gestational diabetes diagnosis impacts the vulnerable population could bridge the gaps in the delivery of health care hence promoting a positive change of behavior. However, most patients with gestational diabetes from the Bronx region in New York reveal that financial concerns influence a lack of awareness of gestational diabetes, prevention, and treatment factors. Also, factors such as medical access, poor post-partum follow-up, communication barriers, and psychological stressors hinder effective treatment of the condition (Daneshmand et al., 2019). Other factors hindering effective remedies and solutions include a lack of affordability of healthy foods, instability among households, transportation challenges, and a consistent schedule. In a study by Daneshmand et al. (2019), the findings revealed that a significant relationship exists between immigrants’ status and decreased odds of insulin treatment. The medications for treating diabetes are costly, and patients also fail to adhere to the prescribed medicines.

Additionally, medical practitioners experience various diagnostic challenges, which have adverse consequences among patients diagnosed with gestational diabetes in the Bronx. There are some risk factors for early gestational diabetes mellitus published in the diabetes professional societies and the American College of Obstetricians and Gynecologists (ACOG) (Daneshmand et al., 2019). The risk factors include a history of gestational diabetes in a previous pregnancy, conditions of impaired tolerance to glucose in the body, first-degree relative with type-2 diabetes, and a history of delivering an infant with a low birth weight (Daneshmand et al., 2019). The screening recommendations entail recognition of a patient’s body mass index (BMI) threshold.

Most of the Bronx medical practitioners do not use the risk factors to identify whether a patient may be at risk of gestational diabetes. Besides, risk factors alone do not aid in the identification of patients with gestational diabetes. Instead, patient reporting is an adequate contributing factor, which is inadequate among the black patients residing in the Bronx, New York. According to Daneshmand et al. (2019), nuances exist in assessing gestational diabetes risk among patients with a family history of type 2 diabetes. The risk increases with poor lifestyle choices in a patient. The conclusion derived from this is that there are insufficient treatments and solutions to the gestational diabetes mellitus problem affecting the black people in the Bronx.

Legislative Section

Legislative Background of the Problem

Diabetes poses health equity challenges, primarily due to its prevalence, incidence, and complication, varying depending on race or ethnicity, region, and income (Suwannaphant, 2017). In a study by Suwannaphant (2017), the results showed that low socioeconomic status is one of the associated risks of diabetes. Socioeconomic status refers to the full measure of an individual’s or family’s economic and social position (Suwannaphant, 2017). Some of the SES factors are risk factors for gestational diabetes development and include marital status, age, education level, income, occupation, residential area, and current liability. Understanding the effects of these socioeconomic factors on gestational diabetes development among the Black women in the Bronx region is the first step towards understanding the problem’s legislative background.

Low socioeconomic status and education level are associated with an increased prevalence of gestational diabetes (Suwannaphant, 2017). Notably, the Bronx is a region located in the northernmost area of New York City with a growing presence of immigrants, including African Americans. They make up over 35% of the area’s total population (Dinapoli & Bleiwas, 2018). The Bronx’s household poverty rate is 28.4%, which is high compared to that of the other four boroughs in New York (Dinapoli & Bleiwas, 2018). In particular, blacks or African Americans are exposed to an array of socioeconomic inequalities, and a majority of them live in poverty. African Americans are exposed to various disparities, including lack of access to proper health facilities. Besides, most of them lack Medicare and Medicaid coverage to cater to their health needs. Such inequalities expose blacks to the risk of gestational diabetes mellitus instead of whites and people from other racial backgrounds.

Additionally, a significant correlation exists between the level of education and gestational diabetes mellitus. According to Martis et al. (2018), people with lower educational attainment have a high prevalence of gestational diabetes. Well-educated persons are likely to be health-conscious. The knowledge acquired through education could gain a high receptiveness to health information and effective communication with health personnel. The blacks in the Bronx region have a low education attainment level as opposed to other races.