By Abdul Qadir Qureshi
(Pakistan News & Features Services)
The first meeting of the Gestational Diabetes Mellitus (GDM)
Advocacy Board was held to have an overview of the GDM in Pakistan. The Board
has been constituted under the project “Gestational Diabetes Millitis
Prevention and Control Program – Pakistan.’
The idea was approved and supported by the Baqai Medical
University. Dr Shabeen Naz Masood, Consultant Obstetrician and Gynaecologist
and M.S of Sobhraj Maternity Hospital, has been actively involved in proposing
and initiating the project.
The proposal was approved by the World Diabetes Foundation
(WDF). It is a WDF funded project. The project has guidance and mentorship of
Prof Zahida Baqai, Vice chancellor of Baqai Medical University and Prof Noor
Jehan Samad. The project has now collaboration and support of professional
colleagues from across the country.
The GDM is a severe and neglected threat to maternal and
child health in Pakistan and Women with GDM become the ideal group for primary
prevention of diabetes, as women with GDM are at increased risk of developing
Type 2 diabetes as are their children.
The diagnosis of GDM offers a unique opportunity in
identifying individuals who will be benefited by early therapeutic intervention
with diet and exercise to delay or even possibly prevent the onset of diabetes.
Large scale studies on GDM have not been conducted in Pakistan. However smaller
studies have reported a prevalence of 3.3 % 3 - 8%. Globally, fifteen per cent
of pregnant women have GDM. A prevalence, as high as 9.9% - 17.8% has been reported
from Tamil Nadu, India.
Considering the ethnic commonalities and similarities
between Pakistani and Indian populations, it would not be unjustifiable to
believe that actual prevalence of GDM in Pakistani women may be much higher
than reported. Moreover, Type 2 diabetes is now occurring at much younger age,
in our population which also indicates towards a higher prevalence of GDM.
Above all, we do not have a recent data on the prevalence of
GDM in Pakistani population. Moreover, complication rates in Pakistani GDM
subjects have been found to be higher , as compared to their Western
counterparts, possibly due to poorer glycaemic control1.Maternal complications
included pre-eclampsia (19%), polyhydramnios (4.6%), and threatened abortion
(3.4%) while fetal complications included macrosomia (13.1%), intrauterine
growth retardation (7.1%) and intrauterine deaths (5.3%).
The meeting was informed that the government allocates a
very limited annual budget for health sector. This allocation becomes further meagre
when women and child health is involved. The limitation of resources is the
major hindrance to the formulation and implementation of wide range health
policies.
It was observed that eradication and control of infectious
diseases is the foremost priority in government health policies.
Non-communicable diseases including diabetes and GDM are yet very low on the
priority list with no structured national policies or strategies regarding GDM
care or prevention. There are no GDM action plans in the country as a whole
while GDM was mostly managed by the individual physicians or institutions in
the public or private health sector.
The meeting was told that viewing the current status of GDM
care in Pakistan and realizing an immediate need for initiating efforts for its
improvement, the GDM project was thought of. It was informed that main
objectives of this 3 years project are to create awareness in the community,
regarding GDM, to train health care professionals in prevention, screening,
diagnosis and management of GDM, to institutionalize GDM screening and to
organize integrated GDM services.
The meeting was briefed about planned project activities and
their outcome and views and suggestions of the participants obtained. It was
informed that the Public Awareness Programs on GDM includes educating 5400
women; public Awareness Campaign on GDM through print and electronic media,
sensitizing further 100,000 people; Development of awareness literature on GDM;
Training courses in GDM for doctors, Midwives and paramedics involved in
obstetric care, training 1620 health care professionals in GDM care;
establishment of three major GDM centres and 30 minor GDM clinics; Screening of
13050 pregnant women for GDM. Estimated identification of nearly 1696 women as
having GDM (at an expected prevalence rate of 13% in South Asians)
The programme also involves dietary and educational
counseling, management and monitoring of identified GDM cases and establishment
of the GDM Advocacy Board, consisting of eminent obstetricians, diabetologists,
and leaders of public opinion in the very context. It was informed that efforts
for institutionalizing the routine screening for GDM among pregnant and
development of “GDM Reference Manual” will a major constituent of the program.
The meeting was informed about the strategies and approach
for the prevention and management of GDM, The meeting noted the barriers and
challenges to early detection of GDM in the wake of Unawareness, particularly
in the female population; lack of training of health care professionals; Non-
affordability on the part of people; Resource constraint in the society and
non-involvement of health authorities.
In her remarks, the chairperson Dr Zajida Baqai,
Vice-Chancellor, Baqai Medical University called forDevelopment of
multidisciplinary approach for screening and management of GDM in Pakistan with
frequent communication and close collaboration between Diabetologists and
Obstetricians.
For achieving national coherence and collaboration for
improving GDM care in Pakistan it was agreed on involving obstetricians and
diabetologists from across the country, Involving primary care physicians,
besides involving journalists from print and electronic media, philanthropists
, pharmaceutical industry, initiating more and more joint GDM projects in the
country with the support of international bodies.
The meeting was informed about developing “National GDM
Guidelines” for the healthcare professionals and recommendations to the health
authorities.
