Presentation at the Global Maternal Newborn Health Conference, October 20, 2015
Background: Gestational diabetes mellitus (GDM) incurs increased risk of complications during labor, poor birth outcomes, and later onset of diabetes in both mothers and their children. The profound lack of screening, detection and management of GDM in developing countries is a serious public health concern. Due to lack of routine screening and surveillance, the extent of GDM in developing countries is largely unknown. With support from Novo Nordisk, Population Services International has prioritized control and prevention of GDM to improve maternal health outcomes while also addressing the growing burden of non-communicable diseases (NCDs) in developing countries. A successful demonstration project from Nicaragua shows promise as a successful model of care.
Methodology: Across four private sector hospitals in Managua, women who have known risk factors for GDM (e.g., overweight, family history of diabetes) are screened at 24 weeks gestation using an oral glucose tolerance test. Those who test positive are offered enrollment in a GDM management program including weekly consultations with a nutritionist, personalized nutrition and exercise plans, regular glucose testing, and regular text reminders/tips. Pharmacists, lab technicians, nurses and doctors receive training and supportive supervision to improve their capacity to screen, diagnose, and manage GDM.
Results: To date, 264 providers have been trained within the program. Of the 2,234 women screened, approximately 18% (398) women have been diagnosed with GDM. Four percent of infants delivered in the program have been born above average weight. Participating hospitals have begun hiring additional nutritionists to strengthen the program. Hospital administrators have agreed to cover the cost of following women up to six months post-partum.
Conclusions: Successful integration of lifestyle interventions using the expertise of nutritionists alongside primary care providers is a promising model to improve maternal health outcomes and simultaneously address the growing burden of NCDs in low and middle income countries.