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5.2 lakh women screened for gestational diabetes in TN
R. PRASAD
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7-8 per cent prevalence seen in women visiting PHCs
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— Photo: D. Gopalakrishnan
Testing protocol: The screening proved that gestational diabetes manifests during all trimesters of pregnancy.
The risk of nearly 83,000 individuals developing diabetes at a later date has been reduced by a simple, low cost intervention by the Tamil Nadu government. In a first-of-its-kind programme in the country, 5.2 lakh pregnant women visiting government-run prenatal clinics were screened for gestational diabetes (GDM) during 2007-08. And 7-8 per cent were found to have elevated glucose level.
Several studies have shown that gestational diabetes — the elevation of maternal blood glucose first seen during pregnancy — when unchecked can put both mother and baby at risk of developing the disease at a later stage.
Easy management
The good news is that simple diet management — splitting a big meal to many small ones — was sufficient to keep the glucose level under check in 90 per cent of the pregnant women diagnosed with gestational diabetes. “This shows how easy it is to reduce the risk of both mother and child from becoming diabetic after a few years,” said Dr. V. Balaji, Consultant, Apollo Hospitals, Chennai.
With about 65 per cent of the 11.38 lakh deliveries in the State taking place in government institutions, the decision to screen all pregnant women visiting these institutions will have great benefits.
“In another six months we can get all pregnant women screened for gestational diabetes,” said Dr. P. Padmanaban, Director of Public Health and Preventive Medicine, Chennai.
Towards this goal, many of the public health centres (PHC) are being equipped to test for diabetes and other diseases. “Already 385 public health centres are equipped with semi auto analysers and we plan to equip another 385 this year,” said Dr. Padmanaban. There are totally 1421 PHCs in the State.
Apart from testing for fasting or postprandial blood glucose level, about 2 lakh women underwent glucose tolerance test (GTT). GGT is considered a gold standard for diagnosing gestational diabetes. “We would be able to test [using GTT] 4 lakh pregnant women this year,” he noted.
The decision to use GTT to confirm the disease is not the only highlight of the screening programme. Even during the first year, the screening programme has adopted the correct time to test for elevated glucose levels.
Early testing
While screening for GDM is usually performed around 24-28 weeks of gestation, many studies have shown that testing as early as during the 16th week can diagnose the disease.
Identifying the disease at an earlier stage will help in early intervention and hence reduce complications.
While it is a general practice to test just once during pregnancy, a study published in the Diabetes Research and Clinical Practices journal last year showed how important it is to test during all trimesters of pregnancy.
The screening programme has adopted not just early screening but screening during all trimesters.
The proof
And the results speak for themselves — 2-2.5 per cent were detected during the 16th week, 2.5-3 per cent during the 24th week, and around 3 per cent during the 32nd week of gestation.
“Nearly 75 per cent of the 2 lakh women [on whom GTT was done] were tested thrice,” Dr. Padmanaban said. He is optimistic that the percentage of women who will undergo testing thrice will increase this year.
The results of the largest screening programme, which shows that gestational diabetes shows up during all trimesters and that early screening is useful in detecting the disease, should be sufficient proof for medical practitioners to follow the testing protocol.
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