Developing a stepwise approach by integrating nutrition and lifestyle modifications in the management of diabetes amongst pregnant women in hospitals of urban Vadodara

Abstract

Introduction: With estimated rates of Gestational Diabetes Mellitus being much higher in India
than West (10-14.3%) and an approximate of about 4 million women being affected nationwide at any
given point in time has made Diabetes a major antenatal concern in India.
Objective: To develop a stepwise approach by integrating nutrition and lifestyle modifications in
management of diabetes amongst pregnant women
Methods: The cross-sectional study comprised of situational analysis under Phase I wherein onetime in-depth interviews of doctors and pregnant women were conducted to identify screening, assessment
and management protocols being used. Six hundred pregnant women from government and private
hospitals across all four zones of Vadodara city were interviewed along with the doctors. Phase II
comprised of an interactive session with doctors and nutritionists to discuss the issues faced while
implementing routine screening, assessment and management protocols. Information was used to develop
stepwise approach.
Results: Prevalence of Gestational Diabetes Mellitus and Diabetes in pregnancy were found to be
different as reported by the doctors versus what was observed by the researcher in the situational analysis.
Majority (76%) women reported of being tested for diabetes using fasting or random blood sugar test.
However, only 16% got Oral Glucose tolerance test done whereas 80% of the doctors reported of getting
OGTT done as an assessment method for these women. Almost all doctors (94.7) reported of diet
counselling being administered to the subjects however, only one hospital had a dietician. A stepwise
approach was developed for screening and assessment of this pregnancy risk using the existing protocols
and including recommendations from Phase-II.
Conclusion: A universal approach for integrated management with nutrition as the key component
for efficient management and risk reduction for a safe pregnancy is the way forward which was the focal
point of this study.