Editorial: Screening for gestational diabetes

Published in The Hindu on April 14, 2007

Foetus1
Photo: Wikimedia

The recent decision by the Tamil Nadu Government to screen all
pregnant women visiting government-run prenatal clinics for
gestational diabetes – the first programme of its kind in the country
– is a fine intervention by the state to protect the welfare of its
people. A community-based study involving nearly 7,000 pregnant women in the State, which was done with active cooperation of government institutions, was revealing. It showed a high prevalence of gestational diabetes – 17.8 per cent in the urban, and 10.4 per cent
in the rural, population. These findings are consistent with what
other small-scale studies in different parts of the country have
found.  With nearly 60 per cent of deliveries taking place in
government institutions, about 600,000 women will be screened for
gestational diabetes – the elevation of maternal blood glucose first
seen during pregnancy. While the importance of monitoring and
controlling blood sugar levels in diabetic women is well understood,
this cannot be said of women who develop diabetes during pregnancy. It is an irony that despite the high prevalence of diabetes in the
country, national guidelines were drawn up only last year to screen
all pregnant women. Screening for, and controlling, gestational
diabetes is the easiest and most cost-effective prevention strategy.
Timely intervention can help substantially to reduce the risk of both
child and mother becoming diabetic at a later stage.

Experiments done on rats have shown that the intrauterine environment plays a crucial role in increasing the susceptibility to diabetes even when the genetic risk is minimal. Among Indians – who have a greater genetic disposition to the disease – the intrauterine environment plays an even more crucial role. Although the screening will be done during the 24-28th week so as not to miss out any pregnant woman, gestational diabetes can be detected as early as the 16th week. Nearly 40 per cent of the cases have been diagnosed by this time. That an elevated glucose level leaves its footprints on the foetus even at its earliest stages of development makes out a strong case for screening in the first trimester as well.  Any additional expenditure on this account should not stand in the way of early screening: the cost of controlling the disease once it is detected is negligible. A simple meal management has been found to be sufficient to control high glucose levels in 95 per cent of the cases. There must a special drive to reach the most vulnerable sections of the population in both town and country. Spreading awareness and training private practitioners are imperative to ensure that every pregnant woman in the State benefits.