IDF21-0581 IDF-MENA region guidelines for management of hyperglycemia in pregnancy

Abstract

Background: Hyperglycaemia in pregnancy (HIP) is the most common medical disorder complicating pregnancy. In the Middle East and North Africa region, the prevalence of DM in women of reproductive age group is high and it varies widely between different regions due to variation in screening and diagnostic criteria for the identification of GDM. Universal blood glucose screening at first antenatal booking visit helps in identifying women with HIP. To reduce the future burden of complications of diabetes in adolescents and later age it is necessary to screen and diagnose pregnant women during pregnancy for the appropriate management and control of high levels of blood glucose during pregnancy to reduce the inter generational transmission and to reduce the future number of people with diabetes. The children exposed to diabetes inutero are likely to develop diabetes as early as 12–22 years of age. The longer the duration of diabetes more are the chances of early development of diabetes related complications. Regional guidelines if modified, developed and also implemented may address the issues of screening, diagnosis according to available evidence based protocols. Aim: The aim of the guidelines proposed here is to create a standardized pragmatic approach for the screening, diagnosis, and management of HIP that is effective, simple, and accessible to all HCPs. This will eventually assist in improving clinical practice and preventing long-term health complications in the region. Method: These recommendations are made after reviewing various existing guidelines including American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and American College of Sports Medicine. A literature search was done using PubMed, Cochrane Database, Google Scholar, EMBASE, various systematic reviews, and original articles. Search was done using key words “Hyperglycemia in pregnancy,” “gestational diabetes mellitus,” and “diabetes in pregnancy.” Results: The results will be available after the implementation of this published regional guideline and it will be monitored by regional and local diabetes in pregnancy Registries. Data will be analysed which will be obtained from these registries. The usefulness of the guidelines as a measure of health care practices regarding screening and diagnosis and maternal and perinatal complications data will be used to implement corrective strategy in screening and management of Hyperglycaemia in Pregnancy. The benefits of these guideline will be analyzed and the indicators will be the reduction in Maternal-prenatal complication rates. Discussion: Due to similarities in genetics and pathogenesis, the prevalence of GDM correlates and parallels with T2DM. In MENA region, the prevalence of T2DM varies from 3.9% (Yemen) to 18.3% (Saudi Arabia) and the prevalence of GDM varies from 5.1% (Yemen) to 37.7% (United Arab Emirates). The vast variation among MENA countries is because of dissimilar screening strategies, nonuniform diagnostic criteria for GDM, and economic differences among the countries. This makes accurate assessment and comparison of burden of HIP among the countries very challenging. Regional guidelines if modified, developed and also implemented may address the issues of screening, diagnosis according to available evidence based protocols. The timely diagnosis may reduce the complications of diabetes in maternal perinatal and adult life.