Defining Practices, Outcomes, and Barriers to Gestational Diabetes Mellitus Screening at a Large, Urban Indian Community Hospital

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as a glucose intolerance of varying severity with onset or first recognition during pregnancy. Uncontrolled GDM is linked to various pre-and postpartum complications and long term maternal health issues. Complications of pregnancy due to GDM include abortion, preterm labor, polyhydramnios, oligohydramnios, and fetal death. Complications to the fetus include fetal macrosomia, fetal malnutrition, defects of the neural tube, and cardiac anomalies such as ventricular septal defects and atrial septal defects. In 2010, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) estimated that the prevalence of gestational diabetes mellitus (GDM) in Southeast Asia was 25%. Among the various populations globally, Indians have a higher frequency of GDM proving the need for an efficient screening process. This was an observational study conducted at large, urban community hospital in India. The purpose of this study was to define the patient population, GDM screening practices, and reasons why some women did not get screened for GDM. METHODS: This was an observational study conducted at a community hospital in south India. The timeframe of the study was from April 2017 to April 2018. The data was collected through patient interview and chart review. The patient's demographic information, risk factors for GDM, course during pregnancy, method of GDM screening used, mode of delivery, maternal, and neonatal outcomes were collected by a simple questionnaire. When accessible, data collected through patient interview was verified by the patient's chart. The inclusion criterion was post-partum women who delivered at Apollo General Hospital. The exclusion criterion for study participants was women with pre-GDM. FINDINGS: 55 interviews were conducted. The mean age at delivery was 24.5 years (n = 55). The mean gestational age that prenatal care was established was at 4.7 months (n = 54). Of the 42 of the 55 patients (76%) who were screened for GDM, 5 patients (9%) were diagnosed with GDM. All 42 patients were screened using the WHO 1999 criterion. Only 7 of the 42 patients were screened between 24 and 28 weeks. The mean gestational month that GDM screening occurred at the hospital was at 5.9 months (n = 40). Of the 13 patients who were not screened, 9 did not get screened because of physician recommendation. 4 were not screened because of lack of patient knowledge. INTERPRETATION: The incidence of GDM in this population was 9%. Although the screening method was standardized, the rate of screening was not universal (76%). Most women were not screened between 24 and 28 weeks, which is recommended by the American College of Obstetricians and Gynecologists (ACOG). Based on this study, future research should explore if there are any harmful consequences from not screening between 24 to 28 weeks in this population and consider educational outreach opportunities.