Prevention of diabetes in mother and child, India

Objectives

As diabetes and impaired glucose tolerance starts to affect people in the developing countries at an increasingly younger age, more pregnancies are at risk of being complicated by the presence of abnormally high blood sugar in the mother - a condition called as gestational diabetes. If gestational diabetes (GDM) remains undiagnosed or is left untreated, it can have severe consequences for the mother and child. Complications can arise before, during or after birth, and GDM is associated with high rates maternal and neonatal morbidity and mortality.

Unfortunately, the risk of morbidity does not stop when the child is born. Mothers with GDM and their offspring are at an increased risk of developing obesity and diabetes type 2 later in life. However, by leading a healthy lifestyle, mother and her offspring may be able to delay or prevent the onset of diabetes.

The overall aim of the project is to prevent development of diabetes and its complications in two generations by screening, diagnosing, adequately treating pregnant women with GDM and ensuring a healthy lifestyle post pregnancy.

Approach

Dr. V Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre will in collaboration with the Ministry of Health in the southern Indian state of Tamil Nadu implement this project. Dr. V Seshiah Diabetes Research Institute has previously implemented WDF08-312 in Tamil Nadu. This project will have a different approach than the previous one, since it will also focus on the follow-up of GDM mothers and their children for several years.

Screening and follow up

Over 7,000 women attending antenatal services will be screened for GDM according to the WHO standards. Pregnant women diagnosed with diabetes will be registered in a GDM registry where they will have their basic biological measurements assessed and recorded. Women with GDM will be provided optimal care and complications and pregnancy outcomes recorded. Women diagnosed with GDM will have their blood glucose level tested six weeks after childbirth and every year after that. The health care workers will emphasize the importance of follow up for the GDM women in order to reduce their risk of developing diabetes later in life. Women with GDM will be encouraged and educated to initiate a healthier lifestyle. The project will investigate on regular basis the out-come in terms of diabetes prevalence and other risk factors in women with previous GDM and their children. It is expected that at least 1,200 GDM mothers and their off springs will be followed over five years; a control group of 400 women without diabetes will be similarly followed.

Capacity building

Initially, a team consisting of diabetologists, obstetricians, nutritionists, neonatologists, physiotherapists and diabetes educator nurses will be in charge of the management of GDM women, until training sessions is initiated for primary health care doctors, village health nurses, and community health workers. They will be involved in interactive training sessions that will be conducted every month for the first two years and thereafter twice a year. The training sessions will address several aspects of GDM; diagnosis, care, treatment, motivation for lifestyle change, healthy living for the mother and child in order to empower these health care professionals to identify and manage GDM themselves.

Advocacy and awareness

Mothers with GDM will be sensitized on the disease and its implications throughout pregnancy and the increased risk of development of diabetes type 2 after pregnancy for both the mother and the child. They will be taught to prevent the development of diabetes and ways to control abnormal glucose levels. The mothers tested for GDM will be counseled on lifestyle modifications like healthy nutrition habits and physical activity. The changes initiated in this project are expected to influence the rest of the family.

The WDF-funded project will run for five years, but the project partner expects to continue with the project 10 years after completion. Information gained through the GDM registry, will be used to follow the women with GDM and their offspring's development of diabetes.

Results at completion

- 5,263 pregnant women screened for gestational diabetes and 998 have been diagnosed with GDM.
- 1,200 women without gestational diabetes and 800 women with gestational diabetes incl. their children (app. 2000 children) followed-up
- 26 training sessions conducted for health care providers including doctors, nurses and lab technicians.
- 108 awareness camps conducted