Screening and diagnosis of gestational diabetes mellitus – relevance to low and middle income countries

Abstract

Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy. Ever since the first systematic evaluation of the oral glucose tolerance test by O’Sullivan and colleagues was carried out in 1964, there has been controversy with respect to the optimal screening and diagnostic criteria to detect GDM. The recently proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM has found fairly widespread acceptance, but it is still debated by several societies. This review intends to provide an overview of the evolution of the screening and diagnostic criteria for GDM. Debatable issues regarding optimal screening strategies, especially in the low resource settings of low and middle income countries are highlighted. The recent Women in India with GDM Strategy (WINGS) project carried out in Chennai, India tried to develop a Model of Care for GDM suitable for resource constrained settings. The findings related to screening and diagnosis of GDM based on WINGS are also highlighted in this review. Based on the WINGS experience we believe that despite the constraints in low and middle income countries at the present time, the IADPSG criteria appears to be the best. This will also help to bring out a uniform criteria for screening and diagnosis of GDM worldwide.

The Challenges and Recommendations for Gestational Diabetes Mellitus Care in India: A Review

“…Among the 25 studies on GDM, 6 (12, 13, 18–21) were on screening, 7 (10, 11, 13, 20, 22–24) on diagnosis, 9 (10, 11, 23, 25–30) on management, 8 (26–29, 31–34) on awareness, and 5 (31, 35–38) on epidemiology. The increase in the total number of studies is due to the single studies that focused on more than one topic.…”

“…The increase in the total number of studies is due to the single studies that focused on more than one topic. Of the 25, 8 studies (12, 20, 21, 25, 27, 28, 30, 32) were literature reviews/editorials, 13 (10, 13, 19, 22, 26, 31, 35–38) epidemiological studies and surveys, and 4 (11, 18, 23, 34) reports/practice guidelines. The characteristics of these studies are also listed in Table 1.…”

Pregnancy outcome of gestational diabetes mellitus using a structured model of care : WINGS project (WINGS‐10)

“…Although the targets for glycemic control are well defined, there is great variation in the way GDM is managed worldwide. This is particularly true in resource‐constrained settings where several barriers related to socioeconomic challenges exist . To tackle some of these challenges, the Women in India with GDM Strategy (WINGS) project was developed by the International Diabetes Federation (IDF).…”

Modification of WHO diagnostic criteria for gestational diabetes: implications for classification of hyperglycemia in pregnancy

“…[20][21][22] The implications of applying the 2013 WHO modifications on the prevalence of GDM, the management of hyperglycaemia and the resulting pregnancy outcome is not known. The capacity for adopting and managing the consequences of implementing the new WHO guidelines is critical for health care services all over the world and particularly in LMICs with very limited resources for screening and treatment.…”