Defining Screening Practices for Gestational Diabetes Mellitus at a Large, Urban Indian Community Hospital

BACKGROUND: The aim of this project was to outline screening practices for gestational diabetes mellitus (GDM) at Apollo General Hospital in Hyderabad, India to understand if GDM was being reliably diagnosed. Current screening guidelines for GDM advocate using an oral glucose challenge test in all high-risk women. Indian women have a 11-fold increased risk of developing GDM, demonstrating the need for a consistent and reliable screening practices. HYPOTHESIS: If Apollo General Hospital in Hyderabad, India is administering the gold standard screening method for GDM, then pregnant women coming to Apollo should receive an oral glucose tolerance test during their pregnancy. METHODS: A chart review of all deliveries at Apollo General Hospital from its opening in 2012 to 2016 was completed. Information from each chart regarding the hospitalﾒs screening practices for GDM including procedures, results, and follow-up practices was collected. RESULTS: GDM screening rates were high (92%), but not universal. Of the 208 patients reviewed, only 51% received a GTT or GCT sometime during pregnancy. An equal percentage of patients received either an RBS (36%) or GTT or GCT (36%) as their first screening test. The remaining patients received an FBS (21%) or PPBS (0.5%) as their first screening test. 8% were not screened for gestational diabetes mellitus during their pregnancy. 10 out of 208 reviewed patients were diagnosed with GDM, of whom 5 received either a GTT or GCT (45%). The prevalence of GDM at Apollo was 4.8% compared to global prevalence of 6%. CONCLUSIONS: Overall screening for GDM is high at Apollo General hospital. However, the screening practices vary considerably per patient, and only around 50% of women had received the gold standard test during their pregnancy. In addition, the prevalence of GDM at Apollo was lower than the global prevalence of 6%. This combined with the fact that Indian women have a 11-fold increased risk of developing GDM argue that RBS, FBS, PPBS or HbA1c may not be adequate tests to screen for GDM. Inconsistent screening practices prove the need for standardization and inquiry into patient and provider factors that influence the current variability in testing, as undiagnosed GDM can have serious consequences for both the mother and child.