India has the second largest number of people with diabetes in the world. Not surprisingly therefore, the prevalence of gestational diabetes mellitus (GDM) in India is also alarmingly high. Indian women are more likely to develop GDM compared to Caucasian women.
Estimates on the prevalence for GDM in India vary greatly; from low figures in the northern region of Jammu, to higher figures reported in the southern state of Tamil Nadu. These widely ranging statistics may reflect a true variation in GDM prevalence throughout the subcontinent, but may also be partially accounted for by discrepancies in protocols for screening and diagnosis, and access to care or changes in risk factors in different geographic regions.
Unfortunately half of all women with GDM live in rural areas where appropriate healthcare is often not available.
Criteria for diagnosis of GDM
While the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM diagnosis has been validated in many populations, obtaining three blood samples, as required by the these criteria, will pose a huge challenge in rural areas of India.
The older World Health Organization (WHO) criteria, which require a single 2 hour measurement with a value of 140 mg/dl or above to diagnose GDM, seems to be most appropriate for the Indian population. This was recently validated against the IADPSG criteria.
Improved care of GDM will necessitate large scale training of health care providers, doctors, nurses and village health workers. Insulin should be made available so that good control of GDM can be achieved and large scale screening undertaken to prevent and manage this disease where possible.
Tackling the problems of GDM will not only improve the outcomes for the mother and the foetus but also help to prevent future diabetes in the mother and in the subsequent generations.