LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 209-210
Post-partum screening of gestational diabetes: Opportunities for integration with existing public health
Sanjay Kalra1, Yashdeep Gupta2
1 Department of Endocrinology and Metabolism, Bharti Hospital, Karnal, Haryana, India
2 Department of Medicine, Government Medical College and Hospital, Chandigarh, India
|Date of Web Publication||16-Jun-2015|
Department of Endocrinology and Metabolism, Bharti Hospital, Karnal, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalra S, Gupta Y. Post-partum screening of gestational diabetes: Opportunities for integration with existing public health. Indian J Community Med 2015;40:209-10
|How to cite this URL:|
Kalra S, Gupta Y. Post-partum screening of gestational diabetes: Opportunities for integration with existing public health. Indian J Community Med [serial online] 2015 [cited 2021 Jul 23];40:209-10. Available from: https://www.ijcm.org.in/text.asp?2015/40/3/209/158875
India has an extensive network of public healthcare centers, spread over the country. Concerted efforts by the government have helped the country achieve significant progress in the field of public health. The eradication of smallpox, guinea worm, and polio are a few examples of success in infectious disease control which have been achieved in recent decades.
India now faces new challenges in the form of non-communicable diseases [NCDs], such as diabetes mellitus.  Various national programs have been rolled out to detect, prevent, manage, and limit the negative impact of these diseases.  NCD control, though, is a different ball game. Infectious diseases are characterized by an acute, monophasic course, and are usually amenable to prevention and cure. NCDs are chronic and indolent, associated with suboptimal lifestyle, and often cannot be cured. Long-term follow-up, including investigations and management, are needed for effective control.
It makes sense, however, for a resource-constrained nation, such as India, to integrate NCD control programs with existing systems for acute illness prevention and management. The Indian Public Health Standards [(2012)] acknowledge this in their recommendations for various levels of healthcare facilities.  Utilization of pre-existing systems not only improves cost-efficiency but also enhances acceptance of NCD control measures by healthcare professionals, and by members of the public.
Post-partum screening [PPS] of women with gestational diabetes mellitus [GDM] is an important strategy for prevention of diabetes. Effective PPS is able to detect diabetes in a high risk cohort at an early stage, allow timely institution of lifestyle measures and pharmacological therapy, and prevent or delay onset of complications due to poor glycemic control.  This, however, is easier said than done. One-third of the women with type 2 diabetes mellitus have history of gestational diabetes mellitus. The conversion rates are high and occurs early particularly in Indians.  Therefore, the window of opportunity as well as action is narrow for Indian women. As per recommendations by American Diabetes Association, women with GDM should be screened after 6 weeks of post-partum for persistent dysglycemia. Woman with normal oral glucose tolerance test [OGTT] can be screened every 3 years, and with impaired OGTT, annually. However, current evidence shows that PPS rates are below optimal levels, not only in India but also in developed countries as well. 
Various methods have been utilized to improve the follow up of women with GDM. , However, these resource-intensive strategies cannot be replicated on a mass scale, especially in resource-poor countries.
There is a need, therefore, to integrate PPS and motivational strategies for PPS, in the existing healthcare system. Thankfully, such opportunities for integration do exist [Table 1]. [Table 1] lists various windows of opportunity, available in standard Indian obstetric and pediatric care,  which can be used to promote PPS. PPS can easily be integrated in existing national health programmes, instead of creating a new scheme for it. Facilities [glucose testing, trained healthcare workers] required to carry out PPS exist from primary health centers onwards. The woman should be asked, and her discharge card should be checked, whether she had gestational diabetes during pregnancy. Seventy-five gram OGTT is the gold standard test which is recommended for diagnosis. However, fasting plasma glucose can be done by venipuncture, if OGTT is not feasible. Though we have based this discussion upon the Indian health system, other countries offer similar opportunities for patient-provider contact, in which PPS can easily be included.
| References|| |
Ramachandran A, Snehalatha C, Samith Shetty A, Nanditha A. Primary prevention of Type 2 diabetes in South Asians - challenges and the way forward. Diabet Med 2013;30:26-34.
Singh K, Reddy KS, Prabhakaran D. What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India? Indian J Community Med 2011;36:S23-31.
Indian Public Health Standards [IPHS] Guidelines for Primary Health Centres. Available from: http://mohfw.nic.in/NRHM/IPHS_Revised_Guidlenes_2012/Primay_Health_Centres.pdf. [Last accessed on 2014 Feb 2].
Kim C. Maternal outcomes and follow-up after gestational diabetes mellitus. Diabet Med 2014;31:292-301.
Kale SD, Yajnik CS, Kulkarni SR, Meenakumari K, Joglekar AA, Khorsand N, et al.
High risk of diabetes and metabolic syndrome in Indian women with gestational diabetes mellitus. Diabet Med 2004;21:1257-8.
Keely E. An opportunity not to be missed-how do we improve postpartum screening rates for women with gestational diabetes? Diabetes Metab Res Rev 2012;28:312-6.
Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus [GDM] services, a systematic review. BMC Pregnancy Childbirth 2014;14:41.