Diagnosis & Management of Gestational Diabetes Mellitus

1 Diagnosis & Management ofGestational Diabetes MellitusTechnical and Operational GuidelinesDiagnosis & Management of Gestational Diabetes MellitusTechnical GuidelinesAny part of this document may be reproduced and excerpts from it quoted without permission provided the material is distributed free of cost and the source is Message List of Contributors 1Mr. Manoj JhalaniAS & MD (NHM), MoHFW2Ms. Vandana Gurnani JS (RCH), MoHFW3Dr. Manohar AgnaniJS (Policy), MoHFW4Dr. Dinesh Baswal DC (MH) I/C, MoHFW5Dr.

2 Sumita GhoshDC (MH)6Dr. Chinmoyee DasDADG (NCD), MoHFW7Dr. Anil KapurInternational Diabetes Federation8Dr. V. Seshiah Diabetes Care Centre, Chennai9Dr. Rajesh Khadgawat Add. Prof., Dept. of Endocrinology & Metabolism, AIIMS, New Delhi10Dr. Hema DivakarFOGSI11Dr. Prema RamchandranNutritional Expert, Hyderabad12Dr. Abha SinghHOD OBGY, LHMC, New Delhi13Dr. Himali H. SinhaDept. of OBGY, AIIMS, Patna14Dr. Alka KriplaniHOD OBGY, AIIMS, New Delhi15Dr. Pratima MittalHOD OBGY, Safdarjung Hospital, New Delhi16Dr.

3 Vinita DasProfessor and HOD OBGY, KGMC, Lucknow17Dr. S. UmaJD (NHM), Tamil Nadu18Dr. Nikhil TandonProfessor and HOD Endocrinologist, AIIMS, New Delhi19Dr. Ashok Kumar DasDiabetologist, JIPMER, Puducherry 20Dr. Amim QadriMedical College, Rajkot 21Ms. Monita GahlotNutritionist, AIIMS, New Delhi22Dr. Alka MohanChief Dietician, Dept. of Dietetics, AIIMS New Delhi23Ms. Vasundhra SinghSenior Dietician, AIIMS New Delhi24Dr. Neena BhatiaAsst. Professor, Dept. of Food and Nutrition, Lady Irwin College25Dr.

4 Neelanjana SinghNutrition Consultant, Heinz Nutrilife Clinic, President Indian Dietetic Association, Delhi Chapter26Dr. Asheber GaymMaternal Health Specialist, UNICEF27Dr. Apurva RatnuSr. Technical Officer, Maternal Health, IPE Global28Dr. Tarun Singh Sodha IPE Global29Dr. Bulbul Sood Country Director, Jhpiego30Dr. Somesh KumarJhpiego31Dr. Vineet SrivastavaJhpiego32Dr. Rashmi AsifJhpiego33Dr. Ashish SrivastavaJhpiego34Dr. Pooja SharmaJhpiego35Mr. Anand BairagiJhpiego36Dr. Abha DhuriyaJhpiego37Dr.

5 Jyoti BenawriJhpiego38Ms. Celine GomesJhpiego39Dr. Hariprakash HadialLead Consultant, Maternal Health, MoHFW40Dr. Salima BhatiaLead Consultant, Maternal Health, MoHFW41Dr. Narender GoswamiConsultant, Maternal Health, MoHFW42Dr. Bhumika TalwarSenior Consultant, Maternal Health, MoHFW43Dr. Jyoti Singh BaghelConsultant, Maternal Health, MoHFW44Dr. Aishwarya SodhiConsultant, Maternal Health, MoHFW45Dr. Amrita JohnConsultant, Maternal Health, MoHFW46Ms. Pooja ChitreConsultant, Maternal Health, MoHFWList of AbbreviationsANC Antenatal CareANM Auxiliary Nurse MidwifeASHA Accredited Social Health ActivistBMI Body Mass IndexBMR Basal Metabolic RateCEmOC Comprehensive Emergency Obstetric CareCHC Community Health CentreDH District HospitalGDM Gestational Diabetes MellitusIEC Information Education CommunicationIGT Impaired Glucose ToleranceIMNCI Integrated Management of Neonatal and Childhood IllnessesJSSK Janani Shishu Suraksha KaryakramLHV Lady Health VisitorLSCS

6 Lower Segment Cesarean SectionLT Lab TechnicianMC Medical CollegeMNT Medical Nutrition TherapyMO Medical OfficerNCD Non-Communicable DiseasesOGTT Oral Glucose Tolerance TestPHC Primary Health CentrePIP Project Implementation PlanPMSMA Pradhan Mantri Surakshit Matritva AbhiyanPPBS Post Prandial Blood SugarSN Staff NurseTSF Table SpoonfullContentsA. Technical Guidelines1. Introduction 12. Evidence 23.

7 Operational Definition of GDM 34. Technical guidelines on testing & Management of GDM 45. Operational aspects of GDM Programme 246. Records & Registers 297. Monitoring and Quality Assurance 298. Outcome measures to be assessed 309. Key points 3010. Budget 31B. Operational Guidelines11. Goal Strategic Approach and Activities 3812. Operational Plan for rolling out GDM Program 4713.

8 Program Monitoring 52C. Annexure 55 Annexure 1: BMI Chart (Ideal height weight chart) 56 Annexure 2: MNT & Sample diet charts 57 Annexure 3: Food exchange list 64 Annexure 4: Monthly GDM Reporting format for State & District Programme managers 67 Annexure 5: Monthly GDM Reporting Format for Health Facility 68 Annexure 6: Migration form 69 Annexure 7: Supportive Supervision Visit (SSV) Checklist 70 Annexure 8.

9 GDM Management and Follow-Up Register 71 Annexure 9: Logistics Requirement calculation for 5000 Population 72 Annexure 10: Checklist for Calibration of Glucometer 73 Annexure 11: Glucometer Specification 75 Annexure 12: FAQs on Glucometer Calibration 76D. Bibliography 77 Diagnosis and Management of Gestational Diabetes Mellitus Technical and Operational Guidelines11. IntroductionGestational Diabetes Mellitus (GDM) is defined as Impaired Glucose Tolerance (IGT) with onset or first recognition during pregnancy.

10 Worldwide, one in 10 pregnancies is associated with Diabetes , 90% of which are GDM. Undiagnosed or inadequately treated GDM can lead to significant maternal & fetal complications. Moreover, women with GDM and their offsprings are at increased risk of developing type 2 Diabetes later in India, one of the most populous country globally, rates of GDM are estimated to be which is much higher than the west. As of 2010, there were an estimated 22 million women with Diabetes between the ages of 20 and 39 & an additional 54 million women in this age group with impaired glucose tolerance (IGT) or pre- Diabetes with the potential to develop GDM if they become pregnant.