Obstetrician witnessing spike in northern Sask. gestational diabetes rates

An award-winning obstetrician in Prince Albert, Sask. says she is seeing a sharp increase in northern Saskatchewan women with gestational diabetes.

Dr. Lalita Malhotra has helped deliver over 10,000 babies in Saskatchewan over four decades — most from the province's north — and has been invested into the Order of Canada and the Saskatchewan Order of Merit.

Malhotra said it used to be that one out of every 10 of her patients had gestational diabetes, a condition in which women without diabetes develop high blood sugar levels during pregnancy.

Over the last five years, she said that rate has jumped to one out of every two of her patients.

According to Diabetes Canada, gestational diabetes can potentially lead to a more difficult delivery and can increase the risk of the mother's baby becoming overweight and developing type 2 diabetes in the future. 

"This is what my dilemma is," she said. "Why are we going down the hill rather than going up the hill? We should be more educated. We should be improving the things a bit rather than seeing the deterioration of health of the patient."

The people who are reaching out are not reaching out enough to give them that feeling of comfort that they can say what they have to say.- Dr. Lalita Malhotra

Malhotra is also seeing an increase in hypertension in the young, as well as complications in pregnancy and delivery, because many northern women are not getting the nutritional advice or prenatal care they need.

"If I didn't see such a steep rise in all those things, I wouldn't have said anything," she said. "It has been bothering me for the past four or five years."

Malhotra said many northern women and girls are dealing with emotional trauma, abuse and less help from family members.

She said, many years ago, women had plenty of family support — but now, the family dynamics are changing.

"Which is leading to isolation," she said. "And it leads to depression and then this communication and trust goes away and they just don't open up, which leads to a lot of health issues."

A preventable problem

She said much of those complications are preventable, but many northern women do not feel free to reveal underlying, emotional problems to prenatal outreach workers or other people in the health system.

"The people who are reaching out are not reaching out enough to give them that feeling of comfort that they can say what they have to say," she said.

Malhotra said health staff need to provide an environment that encourages frank conversations.

"We need to give them an opportunity to open up so they feel confident," she said. "So we need some staff or some resources with which the girls can feel confident enough to open up and say what is going on in their life."

She said she often sees patients who come in with an issue such as a sore throat, but whose expression is giving away a deeper problem.

"But if you look at her eyes, they're such sad eyes," she said. "And if you go into it and ask, 'What is it, really, that is bothering you? A sore throat is one of those things, but why are you not looking happy?'"

"If you bring it up, then they'll see, 'Oh, somebody has a concern about my health, my emotional health.'"

Malhotra is urging health workers to approach northern women as an individual, "rather than a number."

"Bringing up the subject, looking into the patient's eye," she said. "The nurse can do that and the social worker can do that."

"I think once they open up, I think a lot of things will get sorted out — isolation, depression, abuse."

Patients need to be included

Dr. Alika Lafontaine practised in Saskatchewan before moving to northern Alberta.

He agrees with Malhotra that patients need to be included in the system and not seen as just a number.

"I think that's a struggle for a lot of northern women and northern Indigenous women patients in Saskatchewan," Lafontaine said.

He said because of better resources or because there's more availability in the southern regions of Sask., health care providers are better at handling the stress that comes with dealing with patients.

He noted in northern Alberta, there are a small number of medical providers who have to deal with a high level of demand for service from patients who have a hard time accessing adequate care.

"It's often difficult for the patients to trust the providers, because they've had bad experiences in the past with them, or they've been interrogated or not believed when they share certain things," Lafontaine said.

He noted sometimes, care providers have adopted stereotypes or beliefs about patients and the way they present themselves in their region.

Sometimes, care providers have problems helping patients find their way through the health system because the resources are simply lacking.

He said patients in the health system feel different levels of safety when they're talking with medical professionals about sensitive issues.

"Sensitivity eventually needs to give way to safe environments, free of hostility, and having patients really feel like they're included within the system," he said.