Expectant moms missing out on key test: Study

As many as 16% of expectant mothers, mostly from middle and lower-income backgrounds, availing antenatal checkups at three public hospitals in the city were found to be suffering from gestational diabetes mellitus (GDM), a three-year study has revealed.

Worse, they did not know they suffered from the condition until screened as part of the study.

Currently, pregnant women are not administered Oral Glucose Tolerance Test (OGTT), except if random blood sugar test shows high levels of glucose, which does not always flag GDM, say researchers who did the study.

Hence, they have made a proposal to the state health department to make OGTT mandatory.

It is common knowledge that babies born to obese mothers or those having gestational diabetes have an increased chance of various metabolic disorders.

The study conducted by the Indian Institute of Public Health, Bengaluru, on 1,120 mothers concluded that interventions focused on obesity prevention in women and effective screening of gestational diabetes may contribute to reducing childhood obesity in India.

The study published in Clinical Epidemiology, an international, peer-reviewed, open-access journal, on December 27 surveyed 1,008 women from the state health department’s Jayanagar General Hospital.

In addition, 98 women from BBMP’s Srirampuram Referral Hospital and 14 women from New Bagalur Layout Urban Health Centre that comes under the purview of the BBMP were also screened.

The study found that 184 (16.4%) women suffered from GDM and 109 (9.7%) women were obese.

“We surveyed women in their second trimester of pregnancy. The oral glucose tolerance test is administered after 24 weeks of pregnancy. When we are trying to make an estimate, we adjust for number of gestational weeks as one of the variables. It is all accounted for,” said Giridhar R Babu, primary author of the study and Professor, Head-Lifecourse Epidemiology, Indian Institute of Public Health, Bengaluru.

“The people who come to government hospitals are those from low and middle-income backgrounds,”explained Babu. “Nobody does screening for GDM. For obesity, there are no special interventions. But it is as risky as gestational diabetes. Random blood sugar test is not a sensitive test for glucose intolerance. Plus the GDM screening is referred outside that is not done in a uniform way, plus many women don’t go for it.”

The problem with determining obesity is that one never knows if the woman was obese before pregnancy or not because everybody puts on weight during pregnancy, so the study looked at skinfold thickness, that is, fat deposited below the skin in the biceps, triceps and upper back which is an indicator of obesity before pregnancy. This is a standard test all over the world.

Children are at a risk of diabetes and cardiovascular diseases if nothing is done at the pregnancy level.

“In random blood sugar test, OGTT is recommended only if it is higher than 200 mg/dl. There is 10% difference between the two tests. That means out of 16 women detected in every 100, 11 women can be missed if one relies on random blood sugar test,” Babu said.

Why do public hospitals not administer OGTT?

There are logistical challenges in administering OGTT like manpower and time consumed, said Babu. Drawing blood while fasting and redoing the test two hours after glucose is given may not be feasible for all pregnant women, he added. Women are monitored for gastritis or if they are vomiting during this period. Jayanagar General hospital medical superintendent Dr Kiran Kumar concurred saying a busy 300-bedded hospital like his cannot do routine screening for GDM but does the test once after 22 weeks of pregnancy