Gestational diabetes mellitus (GDM) is a condition where pregnant women without a previous diabetes history experience raised blood glucose levels. The condition has few symptoms but increases risk of severe complications and poor pregnancy outcomes and is diagnosed simply by testing blood sugar level.Women manifesting gestational diabetes are at considerably higher risk of pregnancy-induced hypertension, pre-eclampsia, obstructed labour, need for assisted delivery, post partum haemorrhage and infections. Babies of mothers with GDM are often born large, have an increased risk of incapacitating birth injuries, breathing problems and low blood sugar level soon after delivery. Some of these complications can result in death of both mother and the newborn baby.Later in life both the mother and baby are at considerably increased risk of developing diabetes type 2. GDM is a treatable condition and adequate control of the glucose level can decrease the risk of complications substantially.Moreover identification of GDM provides an opportunity for actions to be put in place to prevent future diabetes in both the mother and the child.
Pan American Social Marketing Organization (PASMO) is implementing this first WDF funded project in Nicaragua, based on the growing problem of diabetes and gestational diabetes. PASMO is collaborating with the National Autonomous University of Nicaragua (UNAN), social security institute hospitals, and Novo Nordisk providing technical assistance, logistic support and co-funding. The project will be implemented in rural and semi-urban areas of the capital Managua. The target group is women who utilise public health services for reproductive health.In order to train the health care professionals adequately, diabetes experts from UNAN will develop training material adapted specifically to the health care workers in Nicaragua. Training will be initiated in collaboration with UNAN and will cover themes as screening, diagnosis, self-management, patient referrals and patient tracking. A total of 102 health care workers in the form of doctors, nurses, nutritionists and laboratory personnel are expected to be trained.Six social security institute hospitals will be fully equipped with the necessary equipment for screening, diagnosis and education of women with GDM. The trained health care professionals will through these centres perform screening and diagnosis of women with GDM and conduct education programmes to sensitise women about a healthy lifestyle in order to avoid development of diabetes type 2 later in life.During their pregnancies, women will receive counselling on control of GDM and the health care workers will provide individually structured counselling programmes to improve self-management. The main focus is on adopting a healthier lifestyle The nutritionists will twice a month provide individual counselling to support the women for this behavioural change. The health care workers will furthermore send the women text messages to encourage and remind them about healthy lifestyle. In order to help the women maintain a healthy lifestyle they will be followed up to at least six months after childbirth.It is anticipated that education of women in healthy behaviour also will benefit the whole family.
• IEC materials produced• Baseline health care provider survey conducted• 562 health care providers from 4 social security institute hospitals trained in GDM risks and management• 18,132 women screened for GDM• 1,050 women with GDM sensitised on diabetes self-management and prevention of GDM