In the battle against diabetes in China, gestational diabetes is one of the first battlegrounds.
In China, the incidence of gestational diabetes is as high as 18.9%, with one in every six pregnant women reporting symptoms of the disease. The disease can cause much harm to both the mother and baby fetus she’s carrying. For instance, it increases the risks for pregnancy-induced hypertension, death to the fetus, as well as polyhydramnios, and it also significantly increases the incidence rate of premature delivery and fetal macrosomia.
Dr. Zhao Nan from Jilin Maternal and Child Health Hospital, in Changchun, China, is on the front lines of this war.
Dr. Zhao had a genetic test for diabetes at the early stages of her pregnancy because she has immediate relatives with diabetes. “I was shocked when I turned out to be at high risk.” In recent years, Zhao has experienced the disease from three perspectives: as the attending physician of a diabetes clinic for pregnant women, as a pregnant woman with a high risk of gestational diabetes, and as the mother of a one-year-old child.
Zhao once told the audience in a TV program: “About 12.6 million people in China are ready to get pregnant, and 18 million are pregnant and giving birth. All types of disease ambush the health of mothers and baby fetuses, often when they least expect it. Among them, gestational diabetes is the most hidden from sight, least valued, but yet an extremely dangerous enemy to both the mother and child.”
Although Dr. Zhao is more familiar with this disease than most people, she still noticed that she had experienced some subtle psychological changes when she discovered she was at high risk of contracting the disease. “Maintain a good diet” kept ringing in Zhao’s head throughout her pregnancy-with the worry of diabetes at large.
“The risk of adverse pregnancy outcomes is very high after developing gestational diabetes during pregnancy.” Dr. Zhao recalled that a woman in a nearby rural area who had been pregnant for 33 weeks (around 8 months), and when she came to the hospital for examination, the hospital noticed that her blood glucose was abnormally high and she had symptoms of gestational diabetes. The doctors tried every means to persuade her to stay in the hospital, but they failed. It may have been that she thought the doctor was trying to scare her by giving her the worst-case scenario.
No one knew the real mentality of the pregnant women. She signed her name on the Letter of Responsibility without hesitation and then went home. Two weeks later, her fetal health began to deteriorate. She went back to the hospital trembling, and said: “I don’t feel the fetus moving as much”. Then, two doctors took turns to check, and did not hear the fetal heartbeat. The words left on the medical certificate were shocking-stillbirth. The baby was already long dead.
This is just one of the many terrible outcomes of gestational diabetes. If the pregnant woman was hospitalized, she could have be immediately pushed into the operating room for cesarean section when any condition occurs. It’s hard to say why she did what she did. She may have been worried about the hospitalization costs, or she may have misunderstood what diabetes was. As a result, the fetus didn’t live to make a choice.
Ms. He, who was married and got pregnant right after graduating from college, often got angry with her mother-in-law. Her mother-in-law heard that folic acid was good for pregnant women and would kept insisting that Ms. He take supplements. When He did not take the supplements, her mother-in-law would get very angry at her. Although taking folic acid during pregnancy has become common practice-and does have its benefits-it is not suitable for all pregnant mothers. Ms. He happened to have a poor metabolism for the stuff and could not be forced to take it as a supplement it during her late pregnancy.
One day, Ms. He went to the hospital for an examination and brought back a report. After seeing the report, her mother-in-law stopped arguing, maintaining that she was wrong but had good intentions.
The report was derived from the gene detection technology based on artificial intelligence (AI) algorithms, which is developed by Jilin Maternal and Child Health Hospital in cooperation with Alibaba Cloud and QingWuTong Gene Health Technology Co., Ltd. The technology can be used for gestational diabetes risk screening, with a prediction accuracy of 83%.
Dr. Zhao calls this technology “a weather forecast of maternal love”. This algorithm can predict the incidence probability based on the clinical data and gene data of pregnant women. Compared with traditional methods, it can intervene 12–16 weeks in advance and reduce the incidence rate by 65%.
At present, 1,300 patients have been examined, and 505 of them are predicted to be at a medium or high risk. Among them, 230 patients were diagnosed with the disease after 24 weeks of pregnancy, and 275 patients had abnormal blood glucose to different degrees.
Dr. Zhao said it costs hundreds of RMB to do genetic testing, so the acceptance rate of pregnant women is relatively low, especially in the northern regions of China. On the one hand, the average income of this area is not exactly high, and on the other hand, the awareness of diabetes prevention is relatively poor as well. In this region of China, people are not willing to spend money on examinations to prevent diseases. They are only willing to spend money when treating diseases. Most of the medical expenses are spent on treatment, and there isn’t much awareness of disease preventing treatments. Therefore, it is of great social significance to promote the general investigation of disease in China.
Ms. Li, 32, is a beneficiary of genetic testing. Her genetic testing report said that “subjects carrying your particular mutation are 20% less sensitive to insulin than non-carriers.” The reference value of high risk was 1.33, while her value reached 4.23, which was close to the highest value of all data currently measured. Later, she paid special attention to her diet and exercise, and finally gave birth, with no risk, to a healthy baby.
In fact, genetic testing during pregnancy, as an evaluation technique, has long been applied in China. Each of us has a lot of DNA fragments in our blood. Cells are metabolized all the time, and DNA in aging cells will be scattered into the blood. We need more powerful tools than ever before to boost genetic testing.
Now you may wonder, why would genetic testing join “the diabetes battlefield in China” at this time?
This goes back to cloud computing-genetic testing requires huge databases and computing power support, while the rapid iteration of AI increases the accuracy of prediction. If gene sequencing can be called “the weather forecast for life”, then AI is “the super engine behind all of this weather forecasting”, while cloud computing is “the highway for gene sequencing.” To end the mumble-jumble, with big data, AI, and the cloud, what used to take two days can now be completed in an hour.
Adding to this, Dr. Gu Fei, an AI scientist from Alibaba Cloud, said that given the maturity of the cloud computing industry and recent breakthroughs in AI algorithms, the arrival of the universal genetic testing era is closer than ever before. In his opinion, the liquid biopsy of gestational diabetes is not complicated. Rather, what’s more complicated is to use AI technology to compare the genes of a certain disease and make accurate predictions with AI technology using data to predict whether a pregnant woman may contract these diabetes. This kind of AI algorithm compares the data of sick patients with the data of healthy people, bringing the genetic evaluation of diabetes in pregnant women into a new light.
This is not the first time that Alibaba has used AI technology for genetic testing. Since 2017, the Beijing Genomics Institute (BGI) has cooperated with Alibaba Cloud to successfully predict 40 cases of tumors during pregnancy with AI technology.
In August 2019, it rained heavily and continuously in Changchun, Jilin, China. Yet, the Jilin Maternal and Child Health Hospitalwas still full of expectant mothers. Filled with hope in their hearts, because they believe that the muddy road that brought them to the hospital will be behind them soon-with brighter, sunnier days ahead. Genetic science and artificial intelligence are bring these bright tomorrows that much closer.