The Ministry of Health has released revised guidelines strengthening its stand on universal screening of all pregnant women for gestational diabetes mellitus (GDM).
According to the report titled “Diagnosis and Management of Gestational Diabetes Mellitus” released last week, if the first prenatal test was found negative, a second test should be done at 24-28 weeks of gestation.
Worldwide, one in 10 pregnancies is associated with diabetes, 90% of which are GDM.
Undiagnosed or inadequately treated GDM can lead to significant maternal and foetal complications. Moreover, women with GDM and their children are at increased risk of developing type 2 diabetes later in life.
Hema Divakar, Federation of Obstetric and Gynaecological Societies of India (FOGSI) ambassador to International Federation of Gynaecology and Obstetrics (FIGO), who is one of the contributors to the guidelines, told The Hindu on Thursday that the focus was on making the original guidelines released in 2014 implementable and feasible in the Indian context.
Pointing out that the original guidelines were implemented with great difficulty in Hoshangabad of Madhya Pradesh on a pilot basis, she said there were several logistical issues and the health workers found it difficult to test all pregnant women. “But every time they came across a hurdle, it was resolved to ensure it is implemented,” she said.
Hoshangabad trial
“Based on Hoshangabad experience, we felt there is an urgent need to prevent and minimise maternal and foetal morbidity associated with GDM. The revised guidelines strengthen the provision of universal screening and management of GDM as part of the essential antenatal package,” she said. The report also underlines post-delivery testing.
Apart from this, the new guidelines provide for creating a cadre of healthcare providers for medical nutritional threrapy and inclusion of oral drugs like metformin for control of sugar.
At the primary health centre, the medical officer should initiate treatment and refer pregnant women with GDM to a higher centre if blood sugar levels are not controlled or there is some other complication, the guidelines said.
According to the guidelines, States are free to choose the number of districts where the programme will be implemented initially, however all districts should be be covered in a phased manner.