Screening for Gestational Diabetes Mellitus: Are Guidelines From High-Income Settings Applicable to Poorer Countries?

Abstract

Gestational diabetes mellitus (GDM) is increasingly acknowledged as a public health problem in developing countries, resulting in both immediate and long-term health effects for mothers and their newborns (1,2). Maternal and fetal complications of GDM range from adaptation problems of the newborn (e.g., asphyxia, respiratory distress, and hypoglycemia) to major obstetric complications such as shoulder dystocia, prolonged or obstructed labor, preeclampsia, or postpartum hemorrhage (2,3). In low-resource settings, where shortages of health care providers as well as lack of skills to manage such complications prevail (4), untreated GDM and its associated conditions can endanger the life of mothers and their newborns. Screening and management of GDM often is not part of routine care in the majority of low-resource settings. Because of this, data on the prevalence of GDM and the incidence of related obstetric and newborn complications are scarce. Most of the research on GDM to date has been conducted in high-income countries where GDM screening is already an established part of antenatal care, and specific procedures are clearly defined in national guidelines. Such guidelines are often absent in low-resource settings where, until now, GDM has played a minor role in the shadow of more obvious determinants of maternal and perinatal morbidity and mortality. Where guidelines are available, they often are not standardized. In various GDM projects in low-resource settings, different guidelines have been used for screening and subsequently had to be adapted to fit into the local context (5). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome study (6), the World Health Organization (WHO) modified previously recommended criteria for the diagnosis of GDM (7) to serve as a basis for universal guidelines. This review will assess which criteria are applied by countries with routine screening for GDM in place and how congruent …